Remote Behavioral Health Utilization Clinician

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

Benefits offered by this job

Remote flexibility

Comprehensive benefits

Bonus eligible

Job summary

CVS Health seeks a Behavioral Health Utilization Management Clinician to support members remotely, ensuring evidence-based care and medical necessity across care levels.

You will coordinate with providers, manage triage and discharge planning, and promote cost-effective utilization while improving outcomes. Louisiana licensure or an RN with psychiatric experience is required, with 3+ years in the field.

Qualifications

• Active, unrestricted Behavioral Health license in Louisiana (LCSW/LCPC/LMFT/LPCC/LPAT/LPC)
• Active, unrestricted Compact RN license with psychiatric specialty experience
• 3+ years Behavioral Health clinical practice experience
• 1+ year EMR documentation experience
• Ability to work Sunday–Thursday, 8:00 AM–5:00 PM CST

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

RN license

EMR experience

3+ years experience

CST hours

Education

Master's degree

RN with psychiatric specialty (BSN)

Tools

EMR systems

Job description

CVS Health seeks a Behavioral Health Utilization Management Clinician to support members remotely, ensuring evidence-based care and medical necessity across care levels.

You will coordinate with providers, manage triage and discharge planning, and promote cost-effective utilization while improving outcomes. Louisiana licensure or an RN with psychiatric experience is required, with 3+ years in the field.