Remote Behavioral Health Utilization Clinician

CVS Health; Illinois; Remote; USD 36,000 - 77,000; Full time

Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician to join our remote team. You will review services to determine medical necessity, apply evidence-based guidelines, coordinate decisions with care teams, and support discharge planning for members across the continuum of care.

The role requires a licensed Behavioral Health professional or psychiatric RN, 3+ years of experience, EMR documentation, and CST 8:00 AM–5:00 PM Sunday–Thursday with possible weekend/holiday

Qualifications

• Active, unrestricted 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.
• 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.

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 effective discharge planning and transitions of care
• Identify members at risk for poor outcomes and coordinate referrals to additional 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

Compact RN license

3+ years clinical experience

Education

Master's degree required for independently licensed clinicians

Bachelor's Degree in Nursing

Tools

EMR systems

Job description

CVS Health is seeking a Behavioral Health Utilization Management Clinician to join our remote team. You will review services to determine medical necessity, apply evidence-based guidelines, coordinate decisions with care teams, and support discharge planning for members across the continuum of care.

The role requires a licensed Behavioral Health professional or psychiatric RN, 3+ years of experience, EMR documentation, and CST 8:00 AM–5:00 PM Sunday–Thursday with possible weekend/holiday