Utilization Management Nurse Consultant- Behavioral Health

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Location: 100% remote position from anywhere in the U.S.

Work hours: 11:30am to 8:00 pm in the Eastern time zone.
 

100% attendance and participation is required during the first 3 weeks of training / 8:30am-5pm EST, Monday-Friday.

• 100% remote position from anywhere in the U.S.A.

• Work hours: 11:30-am-8:00pm Eastern Time Zone.

• Work with providers to secure information to complete medical necessity reviews for Behavioral Health and Substance Abuse services.

• 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.

• WFH and hybrid Colleagues must manage dependent care and other personal responsibilities in a way that allows them to successfully meet job responsibilities while working from their virtual work location. Dependent care performed during work hours is generally not permissible, as it creates the potential for unnecessary interruptions and distractions from work.

Required Qualifications

• 1+ year: Behavioral Health and Substance Abuse concurrent review or prior authorization experience

• 3+ years of acute behavioral health and/or substance abuse clinical experience

• Required to attend the first 3 weeks training with 100% participation from 8:30am-5pm Monday-Friday EST.

• A Registered Nurse that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all non-compact states

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 degree in nursing RN required, BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$29.10 - $62.32

This 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 09/02/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.