Utilization Management Clinician - Behavioral Health, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
-

Contract Type:
Employment contract

Salary:

54095.00 - 116760.00 USD / Year

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Job Description:

Fully remote position utilizing clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, applying evidence based standards and practice guidelines to facilitate appropriate healthcare services for members.

Job Responsibility:

Utilizes clinical experience and skills to assess appropriateness of treatment plans across levels of care
Apply evidence based standards and practice guidelines to treatment
Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
Provide triage and crisis support
Gather clinical information and apply appropriate clinical criteria/guideline to render coverage determination
Coordinate with providers and other parties to facilitate optimal care/treatment
Identify members at risk for poor outcomes and facilitate referral opportunities
Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization
Consult and lend expertise to other internal and external constituents

Requirements:

3+ years of direct clinical practice experience post masters degree
Unencumbered Independent Behavioral Health clinical license in the state where they work (LPC, LPCC, LMHCS, LMHC, LMFT, LCSW) OR RN with 3+ years of clinical behavioral health experience
Masters Degree in behavioral health profession
RN license must have a Bachelors Degree
Proficiency with computer skills including navigating multiple systems and keyboarding
Must be able to talk on the telephone and type at the same time

Nice to have:

Knowledge of mental health and substance abuse disorders
Managed care/utilization review experience
Crisis intervention skills

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
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
Retiree medical access

Additional Information:

Job Posted:
September 27, 2025

Expiration:
October 31, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Utilization Management Clinician - Behavioral Health