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 .

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

Core Competencies

Role fit

Core Competencies

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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 while collaborating effectively with healthcare providers.

Highest-signal resume keywords

Active Registered Nurse LicensureAcute Behavioral Health ExperienceSubstance Abuse Clinical Nursing ExperienceConcurrent Review or Prior Authorization ExperienceComputer Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Critical ThinkingEvidence-Based Clinical CriteriaClinical Practice GuidelinesAuthorization of ProceduresDocumentation MaintenanceClinical Information ReviewPrecertification ProcessesOn-Call CoverageCollaboration with ProvidersEscalation of Cases

Soft Skills

Attention to DetailCommunication SkillsProblem-Solving Skills

Certifications & Qualifications

Registered Nurse LicensureAssociate's Degree in Nursing

Industry Keywords

Behavioral HealthSubstance AbuseConcurrent ReviewPrior AuthorizationInpatient ServicesOutpatient Services

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 a Medical Director referral 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
Provide occasional rotational on-call weekend and holiday 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
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
Associate's degree in nursing (RN) required
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