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Utilization Management Nurse Consultant – Behavioral Health
CVS Health. Apply critical thinking, evidence-based clinical criteria, and clinical practice guidelines to review 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 Behavioral Health and Substance Abuse concurrent review, utilizing critical thinking and evidence-based clinical criteria for effective utilization management. Proficient in navigating multiple systems and maintaining accurate documentation in a fast-paced environment.
Highest-signal resume keywords
Registered Nurse LicensureBehavioral Health ExperienceSubstance Abuse ExperienceUtilization Management ReviewManaged Care 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
Critical ThinkingClinical Practice GuidelinesPrecertification ReviewClinical Information CollectionDocumentation Maintenance
Soft Skills
CollaborationCommunicationProblem-Solving
Tools & Technologies
Computer SkillsMultiple Systems Navigation
Certifications & Qualifications
Active RN LicensureAssociate's Degree in Nursing
Industry Keywords
Behavioral HealthSubstance AbuseManaged CareClinical Call CenterUtilization Management
About the role
Key responsibilities & impact- Apply critical thinking, evidence-based clinical criteria, and clinical practice guidelines to review inpatient and outpatient services requiring precertification
- Use specific criteria to authorize procedures and services or initiate Medical Director referrals as needed
- 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 utilization management review in a fast-paced, computer-based environment
Requirements
What you’ll need- Active unrestricted state Registered Nurse licensure in state of residence required
- 1+ year of Behavioral Health and Substance Abuse concurrent review or prior authorization experience
- 3+ years of acute behavioral health and/or substance abuse clinical experience
- Commitment to attend 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 rotational on-call holiday coverage
- Dedicated workspace free of interruptions
- Dependents must have separate care arrangements during work hours
- Proficiency with computer skills and navigating multiple systems
- BSN preferred
- 1+ years Managed Care (MCO) experience preferred
- 1+ year demonstrated experience in a high-volume clinical call center environment preferred
- Remote work experience preferred
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being, based on eligibility