Utilization Management Nurse Consultant – Behavioral Health

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🔥 1 minute ago

🌵 Arizona, Tennessee – Remote

🌵 Arizona – Remote 🎸 Tennessee – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Apply critical thinking, evidence-based clinical criteria, and clinical practice guidelines to review inpatient and outpatient services requiring precertification • Use specific criteria to authorize procedures and services or initiate Medical Director referrals as needed • Collaborate with providers and collect and review clinical information • Escalate cases when needed • Navigate multiple systems and maintain accurate documentation • Provide utilization management support in a fast-paced, computer-based environment • Participate in rotational weekend and holiday on-call coverage

🎯 Requirements

• Active unrestricted state Registered Nurse licensure in state of residence required • 3+ years of acute behavioral health and/or substance abuse clinical nursing experience • 1+ year of concurrent review or prior authorization, preferably in Behavioral Health and Substance Abuse • Commitment to attend a mandatory 3-week training, Monday–Friday, 8:30am–5:00pm EST, with 100% participation • 1+ years Managed Care (MCO) experience preferred • 1+ year demonstrated experience working in a high-volume clinical call center environment preferred • Remote work experience preferred • Associate's degree in nursing (RN) required • BSN preferred • Ability to work occasional on-call rotational coverage on weekends and some rotational on-call holiday coverage • Proficiency with computer skills and navigating multiple systems • Dedicated workspace free of interruptions • Separate care arrangements for dependents during work hours

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility

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