Nurse Consultant

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 colleagues who care deeply, innovate with purpose, hold themselves accountable and prioritize safety and quality in everything we do.

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.

Key Responsibilities

• Apply critical thinking and evidenced-based clinical criteria to authorise procedures/services or initiate a Medical Director referral as needed.
• Use specific criteria to authorise procedures/services or initiate a Medical Director referral as needed.
• Collaborate with providers, authorise care, and escalate cases when needed, all while navigating multiple systems and maintaining accurate documentation.
• Participate in occasional on-call rotational coverage on weekends and some rotational on-call holiday coverage.

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 behavioural health and/or substance abuse clinical nursing experience.
• 1+ year of concurrent review or prior authorisation preferably in Behavioural Health and Substance Abuse.
• Commitment to attend a mandatory 3-week training with 100% participation.

Preferred Qualifications

• 1+ years Managed Care (MCO) experience.
• 1+ year demonstrated experience working in a high-volume clinical call centre environment.
• Remote work experience.

Education

• Associate's degree in nursing (RN) required, BSN preferred.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

$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.

Benefits

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.