Utilization Management Nurse Consultant- Behavioral Health

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryLocation: 100% remote position from anywhere in the U.S.

Work hours: 11:30am to 8:00 pm in the Eastern time zone.100% attendance and participation is required during the first 3 weeks of training / 8:30am-5pm EST, Monday-Friday.

• 100% remote position from anywhere in the U.S.A.
• Work hours: 11:30-am-8:00pm Eastern Time Zone.
• Work with providers to secure information to complete medical necessity reviews for Behavioral Health and Substance Abuse services.
• MUST have the ability to work the occasional on-call rotational coverage on weekends and some rotational on-call holiday coverage (URAC and Client Requirements).
• Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for treatment and services both inpatient and outpatient services requiring precertification.
• Utilization Management nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.
• Position requires proficiency with computer skills which includes navigating multiple systems. Sedentary work involves periods of sitting, talking, listening and computer use. The majority of the time is spent at a desk and on the telephone collecting & reviewing clinical information from providers.
• WFH and hybrid Colleagues must manage dependent care and other personal responsibilities in a way that allows them to successfully meet job responsibilities while working from their virtual work location. Dependent care performed during work hours is generally not permissible, as it creates the potential for unnecessary interruptions and distractions from work.

• 1+ year: Behavioral Health and Substance Abuse concurrent review or prior authorization experience
• 3+ years of acute behavioral health and/or substance abuse clinical experience
• Required to attend the first 3 weeks training with 100% participation from 8:30am-5pm Monday-Friday EST.
• A Registered Nurse that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all non-compact states

• 1+ years Managed Care (MCO) experience
• 1+ year demonstrated experience working in a high-volume clinical call center environment
• Remote work experience

• Associate degree in nursing RN required, BSN preferred

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.