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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 .
Core Competencies
Role fitCore 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 precertification and authorization processes. Proficient in navigating multiple systems and maintaining accurate documentation while collaborating effectively with healthcare providers.
Highest-signal resume keywords
Active Registered Nurse LicensureAcute Behavioral Health ExperienceConcurrent Review ExperienceManaged Care ExperienceClinical Call Center Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Practice GuidelinesPrecertificationAuthorization ProceduresCritical ThinkingClinical Information ReviewDocumentation MaintenanceTelephone CommunicationEvidence-Based CriteriaBehavioral Health KnowledgeSubstance Abuse Knowledge
Soft Skills
CollaborationAttention to DetailProblem-SolvingAdaptabilityCommunication
Tools & Technologies
Multiple Systems NavigationComputer Proficiency
Certifications & Qualifications
Registered Nurse LicenseAssociate's Degree in Nursing
Industry Keywords
Managed Care OrganizationHigh-Volume Clinical EnvironmentOn-Call CoverageInpatient ServicesOutpatient Services
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 specific criteria to authorize procedures and services or initiate Medical Director referrals as needed
- Review clinical information from providers
- Collaborate with providers
- Authorize care and escalate cases when needed
- Navigate multiple systems and maintain accurate documentation
- Collect and review clinical information by telephone
- Provide occasional rotational weekend 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
- Commitment to attend a 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, including 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- CVS Health bonus, commission or short-term incentive program
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being