Remote Behavioral Health Utilization Clinician

CVS Health; Williamstown (NJ); Remote; USD 36,000 - 77,000; Full time

Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician to support remote care for members. The role focuses on determining medical necessity, applying guidelines, and coordinating care across teams.

Strong emphasis on crisis triage, discharge planning, and referrals to programs. The position requires licensed behavioral health professionals or psychiatric RN with specialty experience, plus 3+ years in the field and EMR experience.

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 in settings like psychiatric hospital or residential treatment.
• 1+ year of EMR documentation experience.
• Ability to work Sunday–Thursday, 8:00 AM–5:00 PM CST with occasional flexibility.

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

Active, unrestricted behavioral health

Compact RN license

3+ years behavioral health

EMR documentation

Sunday-Thursday CST availability

Education

Master's degree required for independently licensed Behavioral Health clinicians

Bachelor's Degree in Nursing (RN path)

Job description

CVS Health is seeking a Behavioral Health Utilization Management Clinician to support remote care for members. The role focuses on determining medical necessity, applying guidelines, and coordinating care across teams.

Strong emphasis on crisis triage, discharge planning, and referrals to programs. The position requires licensed behavioral health professionals or psychiatric RN with specialty experience, plus 3+ years in the field and EMR experience.