Remote Behavioral Health Utilization Clinician

CVS Health; Harrisburg (Dauphin County); Remote; USD 61,000 - 130,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Bonus eligibility

Job summary

CVS Health is hiring a remote Utilization Management Clinician to coordinate, document, and communicate UM processes for Medicare DSNP and Medicare Advantage. The role operates Monday–Friday, 8:30am–5pm, with no weekends or holidays.

The position requires an active RN license with psychiatric specialty or relevant experience, plus 1+ year of behavioral health UM experience and 3+ years in inpatient settings. Strong multitasking and independent work are essential.

Qualifications

• Active, current RN license with psychiatric focus or related experience.
• 1+ year in behavioral health utilization review/UM.
• 3+ years in inpatient hospital setting with behavioral health patients.

Responsibilities

• Review and evaluate treatment plans across levels of care in line with evidence-based standards.
• Coordinate and assess healthcare service options to ensure appropriate, cost-effective care.
• Gather and analyze clinical information to determine coverage recommendations and discharge planning needs.
• Collaborate with providers and care teams to support optimal treatment outcomes.
• Identify high-risk members and connect them with internal or community resources.
• Seek opportunities to improve quality and efficiency of care while optimizing benefit use.
• Serve as a clinical resource on UM processes for internal and external partners.
• Work primarily at a computer with extended periods of phone communication.

Skills

RN licensure

Behavioral healthUM experience

Inpatient hospital experience

Multitasking

Education

Master’s-level behavioral health degree

Associate degree

Tools

EHR systems

Job description

CVS Health is hiring a remote Utilization Management Clinician to coordinate, document, and communicate UM processes for Medicare DSNP and Medicare Advantage. The role operates Monday–Friday, 8:30am–5pm, with no weekends or holidays.

The position requires an active RN license with psychiatric specialty or relevant experience, plus 1+ year of behavioral health UM experience and 3+ years in inpatient settings. Strong multitasking and independent work are essential.