Remote Behavioral Health Utilization Clinician

CVS Health; Louisiana; Remote; USD 54,000 - 143,000; Full time

Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a 100% remote, nationwide role. You will review preauthorization requests, coordinate utilization decisions, and collaborate with care teams to ensure appropriate levels of care while managing crisis calls and ensuring quality outcomes.

The ideal candidate holds an active behavioral health license (LPC/LMHC/LCMHC or RN), has 3+ years post-licensure experience in mental health/substance use, and is proficient with

Qualifications

• Active, unrestricted independent behavioral health clinical license in your state of residence.
• Licensed as LPC, LMHC, LCMHC or RN.
• 3+ years of post-licensure behavioral health experience.
• 3+ years of experience with mental health and substance use disorders.
• Ability to manage telephonic and computer-based work simultaneously.
• Hospital-based behavioral health experience.
• Utilization Management or Prior Authorization experience.
• Managed Care experience.
• Fully remote position available anywhere in the U.S.

Responsibilities

• Review preauthorization requests for behavioral health services using evidence-based guidelines and clinical judgment.
• Coordinate, document, and communicate utilization management decisions with providers and stakeholders.
• Ability to manage crisis calls, apply clinical judgment to assess risk, determine support needs, and coordinate appropriate interventions, including escalation for suicide risk, self-harm concerns, and welfare checks when necessary.
• Apply clinical expertise to support quality, cost-effective care and positive member outcomes.
• Work in a fast-paced, queue-based environment while managing multiple priorities.
• Collaborate with providers and care teams to facilitate appropriate levels of care.

Skills

Clinical judgment

Crisis management

Care coordination

Telephonic work

Computer-based work

Utilization management

Prior authorization

Managed care

Remote work

Education

Master's degree in Social Work, Counseling, or Psychology

Bachelor's degree in Nursing with emphasis in Behavioral Health or Psychology

Job description

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a 100% remote, nationwide role. You will review preauthorization requests, coordinate utilization decisions, and collaborate with care teams to ensure appropriate levels of care while managing crisis calls and ensuring quality outcomes.

The ideal candidate holds an active behavioral health license (LPC/LMHC/LCMHC or RN), has 3+ years post-licensure experience in mental health/substance use, and is proficient with