Remote Behavioral Health Utilization Clinician

CVS Health; Athens (GA); Remote; USD 36,000 - 77,000; Full time

Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician to support remote utilization management across states with a Louisiana preference. The role emphasizes evidence-based care, clinical collaboration, and effective discharge planning in a 40-hour CST schedule.

The ideal candidate holds an active behavioral health license or psychiatric RN license and has 3+ years of clinical practice with 1+ year EMR experience. Remote flexibility offered.

Qualifications

• Active, unrestricted behavioral health license in Louisiana or an unrestricted Compact RN license with psychiatric specialty experience.
• 3+ years of behavioral health clinical practice experience (e.g., psychiatric hospital, residential treatment, behavioral health settings).
• 1+ year of Electronic Medical Record (EMR) documentation experience.
• Ability to work Sunday-Thursday, 8:00 AM - 5:00 PM CST, with flexibility for occasional weekends/holidays.

Responsibilities

• Review behavioral health services and treatment plans to determine medical necessity and appropriateness of care.
• Apply evidence-based guidelines and clinical best practices across multiple levels of care.
• Coordinate and communicate utilization management decisions with providers and care teams.
• Provide triage support and crisis intervention as needed.
• Facilitate discharge planning and transitions of care.
• Identify at-risk members 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 license

RN license with psychiatric experience

Education

Master's degree in Behavioral Health

BSN or higher

Tools

EMR systems

Job description

CVS Health is seeking a Behavioral Health Utilization Management Clinician to support remote utilization management across states with a Louisiana preference. The role emphasizes evidence-based care, clinical collaboration, and effective discharge planning in a 40-hour CST schedule.

The ideal candidate holds an active behavioral health license or psychiatric RN license and has 3+ years of clinical practice with 1+ year EMR experience. Remote flexibility offered.