Remote Behavioral Health UM Clinician – Impactful Care

CVS Health; Elm (PA); Remote; USD 36,000 - 77,000; Full time

Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a remote role with a Louisiana preference and a Sunday–Thursday schedule. You will review services for medical necessity, coordinate decisions with care teams, and support crisis intervention and discharge planning to improve member outcomes.

The role requires a behavioral health license in Louisiana or an RN with psychiatric specialty, 3+ years of clinical practice, and EMR documentation experience.

Qualifications

• Active, unrestricted independent Behavioral Health license in Louisiana (LCSW, LCPC, LMFT, LPCC, LPAT, LPC) or
• Active, unrestricted Compact RN license with psychiatric specialty experience
• 3+ years of behavioral health clinical practice experience in settings such as psychiatric hospital or behavioral health treatment
• Master's degree required for independently licensed Behavioral Health clinicians
• Registered Nurse with psychiatric specialty experience and unrestricted nursing license also considered (Bachelor’s Degree in Nursing)
• Experience with Managed Care, Utilization Review, or Utilization Management
• Ability to work Sunday - Thursday, 8:00 AM - 5:00 PM CST with flexibility for weekends/holidays
• Opportunity to improve behavioral health outcomes across continuum of care
• Remote flexibility with a supportive team culture

Responsibilities

• Review behavioral health services and treatment plans to determine medical necessity and appropriateness of care
• Coordinate and communicate utilization management decisions with providers and care teams
• Provide triage support and crisis intervention as needed
• Facilitate effective discharge planning and transitions of care
• Identify members at risk for poor outcomes and coordinate referrals to programs and services
• Promote quality, cost-effective healthcare utilization and positive member outcomes
• Collaborate with internal and external stakeholders to support comprehensive care management

Skills

Behavioral health experience

EMR documentation

Discharge planning

Crisis intervention

Utilization management

Education

Master's degree in Behavioral Health

RN with psychiatric specialty (optional)

Bachelor’s Degree in Nursing

Tools

EMR systems

Job description

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a remote role with a Louisiana preference and a Sunday–Thursday schedule. You will review services for medical necessity, coordinate decisions with care teams, and support crisis intervention and discharge planning to improve member outcomes.

The role requires a behavioral health license in Louisiana or an RN with psychiatric specialty, 3+ years of clinical practice, and EMR documentation experience.