Utilization Management Clinical Consultant - Behavioral Health Job at CVS Health (Work at Home)

Case Manager Registered Nurse

We’re building a world of health around every individual — shaping a more connec...

Location

United States , Newport News

Salary:

60522.00 - 129615.00 USD / Year

CVS Health

Expiration Date

March 26, 2026

Requirements

Must reside near Newport News Virginia, on the Peninsula
Must possess reliable transportation and be willing and able to travel up to 50-75% of the time
RN/BH with current unrestricted Virginia state licensure required
3 years clinical experience (med surg, behavioral health)
Virginia Driver's License
Managed Care experience
Associates Degree in Nursing Required
Registered Nurse License in State of VA in good standing
Independent Behavioral Health License in the state of VA in good standing
Proficient in Multisystem Navigation

Job Responsibility

Assessment of Members
Applies clinical judgment
Using advanced clinical skills, performs crisis intervention
Enhancement of Medical Appropriateness and Quality of Care
Using holistic approach consults with supervisors, Medical Directors and/or other programs
Identifies and escalates quality of care issues
Ability to speak to medical and behavioral health professionals
Utilizes influencing/motivational interviewing skills
Provides coaching, information and support
Helps member actively and knowledgably participate with their provider

What we offer

Mileage is reimbursed
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs

Fulltime

Clinical Case Manager Behavioral Health

We’re building a world of health around every individual — shaping a more connec...

Location

United States , Work at Home

Salary:

60522.00 - 129615.00 USD / Year

CVS Health

Expiration Date

March 27, 2026

Requirements

Minimum 3 years of direct clinical practice experience post master's degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
Active and unrestricted Independent Behavioral Health clinical license in the state of Ohio. ( Ex - LISW, LPCC, LCSW)
Must be resident of Ohio State
Willing and able to travel up to 10% anywhere in the state of Ohio as needed. (staff meetings, Health Forums etc)
Eligible for mileage reimbursement and reliable transportation is required
Masters degree in Behavioral Health/Social service or human services field required. Independently Licensed preferred

Job Responsibility

Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services
Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues
Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated
Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services
Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits
Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives
presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes
Identifies and escalates quality of care issues through established channels
Ability to speak to medical and behavioral health professionals to influence appropriate member care

What we offer

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance

Fulltime

!

Behavioral Health Medical Director

We’re building a world of health around every individual — shaping a more connec...

Location

United States , Work at Home

Salary:

174070.00 - 374920.00 USD / Year

CVS Health

Expiration Date

March 31, 2026

Requirements

Board Certification in Psychiatry
Active and current state medical license without encumbrances, and ability to obtain other state licenses

Job Responsibility

Provide leadership and day-to-day physician oversight for utilization management team, including the management of high-risk cases and medical necessity decisions
Provide comprehensive behavioral health care management to facilitate delivery of appropriate quality care and improve program/operational efficiency involving clinical issues
Participate in the appeals process, including the investigation of adverse events and quality of care concerns
Provide psychiatric leadership to an interdisciplinary utilization management team, including medical/clinical oversight, consultation and training
Provide day-to-day physician oversight including management of high-risk cases throughout treatment/levels of care and medical necessity decisions
Assist with the development, implementation, monitoring and evaluation of the utilization management program and action plan, ensuring quality and appropriateness of care
Assist with the development, implementation and interpretation of medical policy including medical necessity criteria, clinical practice guidelines and new technology assessments
Participate in the development, implementation, and evaluation of clinical/medical programs
Confer with behavioral health practitioners regarding the care of patients with severe, complex and/or treatment resistant illnesses
Identify and address quality of care concerns with providers involved in a member's care

What we offer

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance

Fulltime

!

Behavior Specialist

The Behavior Specialist is responsible for conducting Cognitive Behavioral Thera...

Location

United States , Madison

Salary:

Not provided

Rogers Behavioral Health

Expiration Date

Until further notice

Requirements

Bachelor’s Degree (human services, psychology, social work, or related field preferred)
Relevant Cognitive-Behavioral Treatment (CBT) experience (12 months preferred). Relevant experience may include clinical care, human services, or educational equivalent
Complete Cognitive Behavior Therapy (CBT) or Dialectical Behavior Therapy (DBT) Academy as directed by operations manager under the consultation of the clinical supervisor or director within ninety (90) days of hire/transfer
A SAC-IT, SAC, or CSAC required in WI. A substance abuse specialty authorization applicable to the state hired in is required
Excellent written and verbal communication skills
Formal self-defense training is required with sixty (60) days of the date of hire/transfer. Annual re-certification is required
Compliance with Residential Care Center (RCC) and Community Based Residential Facility (CBRF) employee requirements
If business need should dictate, this role may be required to complete required medication pass training and pass medications in a residential setting

Job Responsibility

Attend and participate in CBT Academy and other training under the direction of the Clinical Services Manager or Director prior to working with patients. Time and training to be determined by the Clinical Services Manager or Director
Provide cognitive behavioral and other therapeutic services, except medication administration, to patients, according to clinical standards of care and under the supervision of the Clinical Services Manager or Director
Participate in weekly supervision sessions with the Clinical Services Manager or Director and communicate with the Clinical Services Manager or Director on an ongoing basis regarding clinical issues
Assure documentation of therapeutic treatment plans, outcome assessments, psychosocial information, and other patient care data is completed within the medical record
Participate in multidisciplinary treatment team meetings and complete treatment plan development
Offer training support to other staff members less familiar with the cognitive behavioral treatment of anxiety, mood, eating, and trauma-related disorders
Document mental health services according to applicable regulations and payer expectations
Communicate with Utilization Review department to provide information necessary to assist in facilitating payment for services
Perform other duties as assigned
Promote department goals and the mission of the Hospital

What we offer

Health, dental, and vision insurance coverage for you and your family
401(k) retirement plan
Employee share program
Life/disability insurance
Flex spending accounts
Tuition reimbursement
Health and wellness program
Employee assistance program (EAP)

Parttime

Care Management Specialist II, D-SNP Team

The Care Management Specialist II utilizes clinical skills and training to perfo...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing for Registered Nurses OR Master's Degree in Social Work for Licensed Clinical Social Workers
Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments
Experience providing care management with complex/catastrophic conditions
Current knowledge of clinical standards of care and disease processes
Critical thinking skill
Excellent customer service skills
Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine and implement the most effective member-centered interventions
Ability to triage immediate member health and safety risks
Ability to sensitively manage member or family responses associated with high acuity cases and support effective coping
Strong verbal and written communications skills to consult effectively with interdisciplinary teams, coordinate care with members and their families, and other internal and external stakeholders

Job Responsibility

Utilizes clinical skills and training to perform essential functions of care management for identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines
Manages a specified caseload across the entire continuum of programmatic levels including those within National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases
Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and facilitating member access to care in a timely and cost-effective manner
Collaborates and communicates with member, family, and interdisciplinary health team to promote wellness and member empowerment, while ensuring access to appropriate services across the healthcare continuum and maximizing member benefit
Serves as clinical advocate for members, active interdisciplinary team member, liaison with other departments and external health care team
Provides direction and assistance to Care Coordinators and to Community Health Workers (CHW) of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines
Uses claims processing and care management software to look up member information, document contacts, and track member progress
Applies clinical knowledge and experience to evaluate information regarding prospective care management members referred by health risk assessment (HRA), risk stratification, predictive modeling, provider’s utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary to meet the member's needs
Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric communication which includes the interdisciplinary team, providers and family or authorized representatives
reviewing member claims histories and identifies intervention opportunities through the professional standards of practice

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

New

Medical Director

Direct, lead and provide professional oversight for medical management activitie...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

3 years of experience in a clinical setting
1 year of experience in physician leadership role, including quality review, utilization review and other managed care functions
Medical Degree
Active, current, and unrestricted license to practice medicine in the State of Arizona (a state in the United States)
Board Certification

Job Responsibility

Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities
Provide direction, support and medical expertise and oversight to areas within the Health Services Division such including utilization management, quality management, case management, medical claims review, and pharmacy management
Provide consultative services throughout the corporation
Communicate with customers regarding their difficult and costly cases
Seek to improve department/division efficiency through effective use of information system tools
Review, and implement medical policies and other medical decision-making policies or procedures
Represent BCBSAZ at professional organizations and acts as liaison with individual health care professionals
Provide professional oversight for the various clinical peer committees
Participate in the appeals and grievance processes
Provide written information to members and providers

Fulltime

Care Manager

Coordinates patient care activities ensuring efficient utilization of interdisci...

Location

United States

Salary:

41.10 - 61.65 USD / Hour

Advocate Aurora Health

Expiration Date

Until further notice

Requirements

Eff. 6/1/2012: BSN preferred, ADN with agreement to enroll in BSN completion program in two years to be completed in five years. Bachelor’s degree in a health-related field plus 3-4 years of clinically relevant experience
OR RN plus 5 years of clinically relevant experience. Graduate from an accredited school of nursing.
Knowledge of basic PC skills.
Ability to prioritize work.
2 years’ clinical experience, recent and relevant.
Effective interpersonal communication skills.
Basic organizational skills.
Problem solving skills.
Utilization of critical thinking in timely decision making.
Current nursing license in State of Illinois or license in relevant clinical work.

Job Responsibility

Coordinates patient care activities ensuring efficient utilization of interdisciplinary resources.
Selects approaches in care coordination that reflect knowledge and integration of regulatory agency standards.
Manages resources in collaboration with patients, families, the health care team, and the community.
Develops and evaluates methodologies for efficient communication among unit nursing personnel and interdisciplinary team members.
Evaluates scheduling of patients/procedures to provide timely and customer-focused services.
Participates in resolution of hospital-based issues which affect patient care outcomes.
Facilitates patient movement through the system in a timely manner by fostering collaboration with care providers at points of transition.
Works collaboratively with internal and external customers. Serves as a liaison between the inpatient rehab unit, subacute facilities, home health agencies and outpatient services.
Interfaces with Utilization Management and insurance providers.
Strengthens and/or creates existing, collaborative, non-binding relationships with other sites of care.

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance

Parttime

New

Case Management Coordinator

We’re building a world of health around every individual — shaping a more connec...

Location

United States , Rockford

Salary:

21.10 - 44.99 USD / Hour

CVS Health

Expiration Date

April 06, 2026

Requirements

Minimum 2 years of experience in behavioral health, social services or human services field
Minimum 2 years of case Management experience
Must reside in Rockford IL
Must have a valid IL Drivers License
Willing and able to travel up to 50- 75% of the time to meet members face to face in Rockford, IL and surrounding areas
Reliable transportation required
Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services required (psychology, social work, marriage and family therapy, counseling)

Job Responsibility

Facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources
Conduct comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services
Identify high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate
Coordinate and implement assigned care plan activities and monitors care plan progress
Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives
Presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes
Identify and escalate quality of care issues through established channels
Utilize negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
Utilize influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
Provide coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices

What we offer

Mileage is reimbursed per our company expense reimbursement policy
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs

Fulltime

Utilization Management Clinical Consultant - Behavioral Health

CVS Health

Location:
United States , Work at Home

Category:
-

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
March 25, 2026

Expiration:
April 17, 2026

Looking for more opportunities? Search for other job offers that match your skills and interests.

Similar Jobs for Utilization Management Clinical Consultant - Behavioral Health

Case Manager Registered Nurse

Clinical Case Manager Behavioral Health

Behavioral Health Medical Director

Behavior Specialist

Care Management Specialist II, D-SNP Team

Medical Director

Care Manager

Case Management Coordinator

Utilization Management Clinical Consultant - Behavioral Health

CVS Health

Location:United States , Work at Home

Category:-

Contract Type:Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:March 25, 2026

Expiration:April 17, 2026

Looking for more opportunities? Search for other job offers that match your skills and interests.

Similar Jobs for Utilization Management Clinical Consultant - Behavioral Health

Case Manager Registered Nurse

Clinical Case Manager Behavioral Health

Behavioral Health Medical Director

Behavior Specialist

Care Management Specialist II, D-SNP Team

Medical Director

Care Manager

Case Management Coordinator

Location:
United States , Work at Home

Category:
-

Contract Type:
Not provided

Job Posted:
March 25, 2026

Expiration:
April 17, 2026