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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 clinical nursing with a focus on acute behavioral health and substance abuse, utilizing critical thinking and evidence-based guidelines for precertification and authorization processes. Proficient in navigating multiple systems and maintaining accurate documentation in a fast-paced environment.
Highest-signal resume keywords
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
Critical ThinkingEvidence-Based Clinical CriteriaClinical Practice GuidelinesUtilization ManagementPrecertificationAuthorization ProceduresDocumentation SkillsNavigating Multiple SystemsBehavioral Health KnowledgeSubstance Abuse Knowledge
Soft Skills
CollaborationCommunicationProblem-SolvingAttention to DetailTime Management
Certifications & Qualifications
Active Registered Nurse LicensureAssociate's Degree in NursingBSN Preferred
Industry Keywords
Managed Care OrganizationHigh-Volume Clinical EnvironmentOn-Call CoverageRemote Work ExperienceClinical Nursing
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 collect and review clinical information
- Escalate cases when needed
- Navigate multiple systems and maintain accurate documentation
- Provide utilization management support in a fast-paced, computer-based environment
- Participate in 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
- 1+ years Managed Care (MCO) experience preferred
- 1+ year demonstrated experience working in a high-volume clinical call center environment preferred
- Remote work experience preferred
- Associate's degree in nursing (RN) required
- BSN preferred
- 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
- Separate care arrangements for dependents during work hours
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