Utilization Management Nurse Consultant - Behavioral Health (Remote)

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 prioritise 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. Work hours: Monday-Friday 11:30am-8:00pm EST. About Us American Health Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organisation founded in 1993. We provide flexible, cost-effective care management solutions that promote high-quality healthcare for members. Position Summary Join our Utilisation Management team as a Nurse Consultant, where you'll apply clinical judgement and evidence-based criteria to review inpatient and outpatient services. You'll collaborate with providers, authorise care, and escalated cases when needed, all while navigating multiple systems and maintaining accurate documentation. This role suits nurses who thrive in fast-paced environments, are highly organised, and comfortable with computer-based work. Key Responsibilities 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, evidence based clinical criteria and clinical practice guidelines for treatment and services both inpatient and outpatient services requiring precertification. Utilisation Management nurses use specific criteria to authorise 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; candidates must have a dedicated workspace free of interruptions. Dependants must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. Required Qualifications Active unrestricted state Registered Nurse licensure in state of residence required. 3+ years of acute behavioural health and/or substance abuse clinical nursing experience. 1+ year of concurrent review or prior authorisation preferably in Behavioural Health and Substance Abuse. Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation. Preferred Qualifications 1+ year Managed Care (MCO) experience. 1+ year demonstrated experience working in a high-volume clinical call centre environment. Remote work experience. Education Associate’s degree in nursing (RN) required, BSN preferred. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $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. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive programme in addition to the base pay range listed above. Great benefits for great people 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 programmes, 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. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programmes, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area. #J-18808-Ljbffr 4062 Aetna Resources, LLC