Utilization Management Nurse Consultant - Behavioral Health (Remote)

CVS Health • Full-time • Remote (Phoenix, Arizona, United States) • $0 / year • 21h ago

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

American Health Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care management solutions that promote high-quality healthcare for members. Join our Utilization Management team as a Nurse Consultant, where you'll apply clinical judgment and evidence-based criteria to review inpatient and outpatient services. You'll collaborate with providers, authorize care, and escalate cases when needed, all while navigating multiple systems and maintaining accurate documentation. This role suits nurses who thrive in fast-paced environments, are highly organized, and comfortable with computer-based work. 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). 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. Remote Work Expectations This is a 100% remote role

; Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. 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 ~1+ year demonstrated experience working in a high-volume clinical call center environment. ~ Remote work experience.

Associate's degree in nursing (RN) required, BSN preferred.

Full time

Pay Range 29.10 - $62.32 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on

Benefits Moments

. We anticipate the application window for this opening will close on: 10/22/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.