Remote Behavioral Health Utilization Clinician

CVS Health; East Honolulu (HI); Remote; USD 36,000 - 77,000; Full time

Job summary

CVS Health in Remote (Louisiana preferred) seeks a Behavioral Health Utilization Management Clinician to ensure evidence-based care and appropriate medical necessity decisions. You will review plans, coordinate with providers, support discharge planning, and collaborate with care teams, with a Sunday–Thursday schedule 8 AM–5 PM CST.

Ideal candidates hold an active behavioral health license, 3+ years in the field, and EMR experience; masters required for independent licensure.

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 (e.g., psychiatric hospital or 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 weekends/holidays
• Experience in Managed Care, Utilization Review, or Utilization Management
• Behavioral health inpatient experience
• Master's degree required for independently licensed Behavioral Health clinicians
• RN with psychiatric specialty experience is considered (Bachelor’s Degree in Nursing)
• Remote flexibility with a supportive team culture
• Opportunity to improve behavioral health outcomes across the care continuum
• Influence quality, access, and effectiveness of behavioral health services

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
• 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 (psychiatric)

EMR experience

Utilization management

Weekend availability

Education

Master's degree in Behavioral Health

Tools

EMR systems

Job description

CVS Health in Remote (Louisiana preferred) seeks a Behavioral Health Utilization Management Clinician to ensure evidence-based care and appropriate medical necessity decisions. You will review plans, coordinate with providers, support discharge planning, and collaborate with care teams, with a Sunday–Thursday schedule 8 AM–5 PM CST.

Ideal candidates hold an active behavioral health license, 3+ years in the field, and EMR experience; masters required for independent licensure.