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Behavioral Health Utilization Management Nurse Consultant
Review inpatient and outpatient behavioral health care for managed-care members, applying clinical criteria to service authorization and provider escalations. This remote role serves CVS Health members in Arizona.
Descriere
- Review inpatient and outpatient services requiring precertification using evidence-based criteria and clinical guidelines.
- Authorize procedures and services based on applicable criteria, or refer cases to a Medical Director.
- Gather and assess clinical information from providers.
- Work with providers and escalate cases when needed.
- Use multiple systems and keep records accurate.
- Conduct utilization reviews in a fast-paced, computer-based setting.
- Perform desk and telephone duties, including sitting, speaking, listening, and computer use.
Cerințe
- Hold an active, unrestricted Registered Nurse license in your state of residence.
- Have at least 3 years of acute behavioral health and/or substance abuse clinical nursing experience.
- Have at least 1 year of concurrent review or prior authorization experience; behavioral health and substance abuse experience is preferred.
- Attend all sessions of mandatory three-week training, Monday through Friday, 8:30 a.m. to 5:00 p.m. Eastern Time.
- Be able to provide occasional rotating on-call coverage on weekends and some holidays.
- Have an associate degree in nursing (RN).
- Be proficient with computers and able to navigate multiple systems.
- Maintain a dedicated workspace free from interruptions.
- Arrange separate care for dependents during work hours.
- Preferred: At least 1 year of managed care organization experience.
- Preferred: At least 1 year in a high-volume clinical call center.
- Preferred: Remote work experience.
- Preferred: Bachelor of Science in Nursing.
Beneficii
- Medical coverage.
- Dental coverage.
- Vision coverage.
- Paid time off.
- Retirement savings options.
- Wellness programs.
- Resources supporting physical, emotional, and financial well-being.
- Eligibility for CVS Health bonus, commission, or short-term incentive programs.