Remote Behavioral Health Utilization Clinician

CVS Health

Wisconsin

Remote

USD 36,000 - 77,000

Full time

10 days ago

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Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician to support members nationwide from a remote location. The role emphasizes medical necessity review, care coordination with providers, and crisis intervention within a structured schedule (Sunday through Thursday, CST).

The position requires a licensed Behavioral Health professional in Louisiana or an unrestricted psychiatric RN with relevant experience, and offers a comprehensive benefits package and opportunities to

Qualifications

Active Louisiana Behavioral Health license OR unrestricted psychiatric RN license
3+ years of behavioral health clinical practice
Experience in psychiatric hospital or behavioral health settings
1+ year of EMR documentation experience
Ability to work Sunday-Thursday 8:00 AM–5:00 PM CST with occasional weekends/holidays
Managed Care / Utilization Management experience

Responsibilities

Review behavioral health services to determine medical necessity and appropriateness of care
Coordinate utilization management decisions with providers and care teams
Provide triage support and crisis intervention as needed
Facilitate discharge planning and transitions of care
Identify members at risk for poor outcomes and coordinate referrals
Promote quality, cost-effective healthcare utilization and positive member outcomes
Collaborate with internal and external stakeholders to support comprehensive care management