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