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CVS Health Careers

Utilization Management Nurse Consultant – Behavioral Health

CVS Health Careers

. Apply critical thinking, evidence-based clinical criteria, and clinical practice guidelines to inpatient and outpatient services requiring precertification .

Posted 11/10/2026full-timeRemote • Arizona • United StatesMid-LevelSenior💰 $29 - $62 per hourWebsite

Core Competencies

Role fit
Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical nursing with a focus on acute behavioral health and substance abuse, utilizing evidence-based criteria for authorization and care management. Proficient in navigating multiple systems and maintaining accurate documentation while providing on-call coverage as needed.

Highest-signal resume keywords
Registered Nurse LicensureAcute Behavioral Health ExperienceConcurrent Review ExperienceUtilization ManagementManaged Care Experience

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills
Clinical Practice GuidelinesPrecertificationAuthorization ProceduresClinical Information ReviewDocumentation Accuracy
Soft Skills
Critical ThinkingCollaborationCommunication
Tools & Technologies
Computer SkillsMultiple Systems Navigation
Certifications & Qualifications
Active Unrestricted RN LicensureAssociate's Degree in Nursing
Industry Keywords
Behavioral HealthSubstance AbuseUtilization Management CriteriaHigh-Volume Clinical Call CenterOn-Call Coverage

About the role

Key responsibilities & impact
  • Apply critical thinking, evidence-based clinical criteria, and clinical practice guidelines to inpatient and outpatient services requiring precertification
  • Use utilization management criteria to authorize procedures and services or initiate Medical Director referrals
  • Collaborate with providers and authorize care
  • Escalate cases when needed
  • Navigate multiple systems and maintain accurate documentation
  • Collect and review clinical information from providers by telephone and computer
  • Provide occasional rotational weekend on-call and holiday on-call coverage

Requirements

What you’ll need
  • 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
  • Mandatory 3-week training, Monday–Friday, 8:30am–5:00pm EST, with 100% participation
  • Associate's degree in nursing (RN) required
  • Ability to work occasional on-call rotational coverage on weekends and some rotational on-call holiday coverage
  • Proficiency with computer skills and navigating multiple systems
  • Dedicated workspace free of interruptions
  • Dependents must have separate care arrangements during work hours
  • Preferred: 1+ years Managed Care (MCO) experience
  • Preferred: 1+ year demonstrated experience working in a high-volume clinical call center environment
  • Preferred: Remote work experience

Benefits

Comp & perks
  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs
  • Other resources supporting physical, emotional, and financial well-being
  • CVS Health bonus, commission or short-term incentive program in addition to base pay