# Nurse Consultant

**Company**: American Health Holding, Inc. (AHH)
**Work arrangement**: remote
**Experience**: senior
**Job type**: full-time
**Salary**: $29.10 - $62.32 per hour
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/Work-At-Home-Arizona/Utilization-Management-Nurse-Consultant---Behavioral-Health--Remote-_R1051758?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_6a6ad4e8-ce0

## Description

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 they do.

**Job Details:**

- Work hours: Monday-Friday 11:30am-8:00pm EST

- Employment type: Full-time

**Job 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.

**Key Responsibilities:**

- Apply critical thinking and evidenced-based clinical criteria to review inpatient and outpatient services requiring precertification

- Use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed

- Participate in occasional on-call rotational coverage on weekends and some rotational on-call holiday coverage

- Proficiency with computer skills, including navigating multiple systems

**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

**Salary Range:**

$29.10 - $62.32 per hour

**Benefits:**

- Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources

## Skills

### Required
- Registered Nurse licensure
- clinical judgment
- evidence-based criteria
- computer skills

### Nice to have
- Managed Care experience
- high-volume clinical call center experience
- remote work experience

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/Work-At-Home-Arizona/Utilization-Management-Nurse-Consultant---Behavioral-Health--Remote-_R1051758?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)