Remote Behavioral Health Utilization Consultant

CVS Health; United States; Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Retirement savings options

Wellness programs

Paid time off

Job summary

CVS Health is seeking a remote Utilization Review Clinician to coordinate, document, and communicate Medicare Integrated/dually eligible member care. This role requires clinical judgment grounded in evidence-based practice and involves collaboration with care teams, discharge planning, and resource optimization.

The position supports deep analytical work from a computer with extensive phone time; requires a Master’s in behavioral health or an RN license in the state of residence, 1+ year in

Qualifications

• Active, current behavioral health license or RN licensure in residence.
• 1+ year behavioral health utilization review/management experience.
• 3+ years inpatient behavioral health experience.

Responsibilities

• Review and evaluate treatment plans across levels of care.
• Coordinate, monitor, and assess care options for cost-effective care.
• Collect and assess clinical information for coverage recommendations.
• Collaborate with providers and care teams to ensure outcomes.
• Identify high-risk members and connect with programs and resources.
• Serve as a clinical resource on utilization management processes.
• Work primarily at a computer with extended phone time.

Skills

Clinical judgment

Care coordination

Communication skills

Critical thinking

Education

Master’s in Behavioral Health

RN degree (BSN preferred)

Tools

EHR systems

Computer proficiency

Job description

CVS Health is seeking a remote Utilization Review Clinician to coordinate, document, and communicate Medicare Integrated/dually eligible member care. This role requires clinical judgment grounded in evidence-based practice and involves collaboration with care teams, discharge planning, and resource optimization.

The position supports deep analytical work from a computer with extensive phone time; requires a Master’s in behavioral health or an RN license in the state of residence, 1+ year in