Remote Behavioral Health Utilization Clinician

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

Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician for remote work with a Louisiana preference. The role runs Monday-Friday or Tuesday-Saturday CST and may require occasional weekend or holiday coverage.

You will review services for medical necessity, apply evidence-based guidelines, coordinate decisions with care teams, and support crisis intervention and discharge planning to ensure quality, cost-effective care for members.

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 of behavioral health clinical practice experience.
• 1+ year of EMR documentation experience.
• Ability to work Monday-Friday 8:00-17:00 CST or Tue-Sat 8:00-17:00 CST with occasional 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 discharge planning and transitions of care.
• Identify at-risk members and coordinate referrals to additional programs and services.
• Promote quality, cost-effective healthcare utilization and positive outcomes.
• Collaborate with internal and external stakeholders to support comprehensive care management.

Skills

Behavioral health licensure

Compact RN license

EMR documentation

Schedule flexibility

Education

Master’s degree

Bachelor’s degree in Nursing

Job description

CVS Health is seeking a Behavioral Health Utilization Management Clinician for remote work with a Louisiana preference. The role runs Monday-Friday or Tuesday-Saturday CST and may require occasional weekend or holiday coverage.

You will review services for medical necessity, apply evidence-based guidelines, coordinate decisions with care teams, and support crisis intervention and discharge planning to ensure quality, cost-effective care for members.