Behavioral Health Clinical Consultant

CVS Health; Missouri; Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits package

Paid time off and retirement options

Job summary

CVS Health is offering a fully remote Behavioral Health Utilization Review role. You will coordinate and document utilization/benefit management for Medicare populations, applying evidence-based guidelines with a focus on behavioral health and complex medical needs.

Required: Master’s-level behavioral health license or RN with psychiatric specialty, plus 1+ year of utilization review and 3+ years inpatient BH experience. 40 weekly hours, EST 8:30-5:00, with benefits and bonus eligibility.

Qualifications

• Requires Master’s-level behavioral health license or RN licensure in residence.
• 1+ year of behavioral health utilization review/utilization management experience required.
• 3+ years in inpatient behavioral health setting with experience with high-need populations.

Responsibilities

• Review and evaluate treatment plans across levels of care per guidelines and coverage criteria.
• Coordinate and assess healthcare service options for Medicare Integrated/dually eligible members.
• Collect and assess information to determine coverage and discharge planning for complex cases.
• Collaborate with providers and care teams to support continuity of care.
• Identify high-risk members and connect with internal programs or community resources.
• Recognize opportunities to improve quality and optimize benefit use for high-need populations.
• Serve as clinical resource regarding utilization management processes and requirements.
• Perform duties primarily at a computer with extended phone work.

Skills

Behavioral health utilization

Clinical documentation

Interdisciplinary collaboration

Computer proficiency

Education

Master's degree in behavioral health

RN degree (BSN preferred)

Tools

EHR systems

Job description

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.

Position Summary

Fully remote role. Monday - Friday 8:30 - 5:00 pm EST

Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program for Medicare Integrated/dually eligible member populations. Applies critical thinking and clinical judgment grounded in evidence-based care and clinical practice guidelines for behavioral health and/or medical conditions, based on program focus. Supports care coordination and benefit management across complex member needs, with attention to quality, service, and appropriate resource use.

Key Responsibilities

• Apply clinical expertise to review and evaluate treatment plans across various levels of care, ensuring alignment with evidence-based standards, clinical guidelines, and applicable benefit coverage criteria.
• Coordinate, monitor, and assess healthcare service options to help ensure Medicare Integrated/dually eligible members receive appropriate, cost-effective care.
• Collect and assess clinical information to determine coverage recommendations, including discharge planning, transitions of care, and coordination of services for members with complex medical, behavioral health, and psychosocial needs.
• Collaborate with providers, care teams, and interdisciplinary partners to facilitate optimal treatment outcomes and support continuity of care.
• Identify high-risk members and connect them with appropriate internal programs, services, community resources, or additional supports.
• Recognize opportunities to enhance the quality and effectiveness of healthcare services while optimizing benefit use for a complex, high-need member population.
• Serve as a clinical resource to internal teams and external partners regarding utilization management processes, member needs, and coordination requirements.
• Perform responsibilities while working primarily at a computer, including extended periods of phone communication.

Required Qualifications

• Must be able to work the posted schedule. The role requires rendering decisions within mandated turnaround times; therefore, schedule flexibility is limited.
• Active, current, and unrestricted Master’s-level behavioral health clinical license in the state of residence (e.g., LMSW, LCSW, LISW, LPC, or comparable), or Registered Nurse licensure in the state of residence with psychiatric specialty, certification, or relevant experience.
• 1+ years of behavioral health utilization review/utilization management experience required.
• 3+ years of experience in an inpatient hospital setting working with behavioral health members. Experience must be recent, or supported by continuous, behavioral health-focused work since the inpatient setting experience.

Preferred Qualifications

• Experience working with Medicare, Medicaid, or dually eligible populations.
• Experience working with geriatric or chronically mentally ill populations.
• Experience supporting high-risk member populations.
• Strong computer proficiency, including navigating multiple systems and accurate keyboarding.

Education

• Master’s degree in a behavioral health field, or Registered Nurse degree (BSN preferred)

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $68.55

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 program in addition to the base pay range listed above.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

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 (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 11/22/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.