Utilization Management Nurse Consultant - Behavioral Health
Free to start · No card · 5 credits the moment you sign up
Job description
Job Title: Utilization Management Nurse Consultant - Behavioral Health (Remote)
Job Location: Phoenix, Arizona, United States
Job Location Type: Remote
Job Contract Type: Full-time
Job Seniority Level:
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Work hours: Monday-Friday11:30am-8:00pm EST.
About Us
American Health Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care management solutions that promote high-quality healthcare for members.
Position Summary
Join our Utilization Management team as a Nurse Consultant, where you'll apply clinical judgment and evidence-based criteria to review inpatient and outpatient services. You'll collaborate with providers, authorize care, and escalate cases when needed, all while navigating multiple systems and maintaining accurate documentation. This role suits nurses who thrive in fast-paced environments, are highly organized, and comfortable with computer-based work.
Key Responsibilities
- MUST have the ability to work the occasional on-call rotational coverage on weekends and some rotational on-call holiday coverage (URAC and Client Requirements).
- Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for treatment and services both inpatient and outpatient services requiring precertification.
- Utilization Management nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.
- Position requires proficiency with computer skills which includes navigating multiple systems. Sedentary work involves periods of sitting, talking, listening and computer use. The majority of the time is spent at a desk and on the telephone collecting & reviewing clinical information from providers.
Remote Work Expectations
- This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.
- Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.
Required Qualifications
- 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.
Preferred Qualifications
- 1+ years Managed Care (MCO) experience
- 1+ year demonstrated experience working in a high-volume clinical call center environment.
- Remote work experience.
Education
- Associate's degree in nursing (RN) required, BSN preferred.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$29.10 - $62.32This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
This job is curated by Lifelancer.
Lifelancer is a talent-hiring platform in Life Sciences, Pharma and IT. The platform connects talent with opportunities in pharma, biotech, health sciences, healthtech and IT domains.
Please apply via Lifelancer platform to get connected to the application page and to find similar roles.
Originally posted on Himalayas
Prepare your application
Use the description above to assess your fit for Lifelancer. This checklist is guidance from Resumize, rather than additional requirements from the employer. Imported listings can be shortened or change after collection, so confirm the complete description and current availability before sending an application.
Match requirements to evidence
Identify the responsibilities and skills the employer explicitly names. For each important requirement, choose one example from your work, education, training, or projects. Explain what you did, how you did it, and what changed as a result. Include a measurable outcome when you can support it. If you lack a requirement, describe related experience accurately instead of adding an unfamiliar skill to your resume.
Put the most relevant examples near the top of your resume. Keep job titles, dates, qualifications, and contact details consistent across your application materials. Use the employer’s terminology when it describes your experience accurately; a copied list of keywords does not explain your contribution. A short, specific bullet is easier to review than a paragraph that mixes several unrelated duties.
Check the working arrangement
Confirm the location, schedule, employment type, and any eligibility requirements on the employer’s site. A remote label does not establish worldwide eligibility or flexible hours. If compensation, benefits, equipment, travel, or contract duration are missing from this listing, write down your questions for the recruiter. Do not assume details from another opening at the same company apply to this role.
Review before submitting
Follow the employer’s requested file format and application instructions. Open your exported resume and check that its text is selectable, its sections read in order, and its links work. Proofread names, dates, and contact information. Share confidential work samples only when you have permission, and use an anonymized example when necessary.
Submit through a trusted employer or recruiting destination. If the original listing has disappeared, search the employer’s careers page for the title rather than assuming the vacancy remains open. Save the application date, job reference, and the version of your resume you sent. Those details help you prepare for a later conversation and avoid submitting conflicting information through several job boards.
Review your resume for writing and readability feedback, or browse other openings if this opportunity is unavailable.