Remote Behavioral Health Utilization Management Consultant

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

Benefits offered by this job

Remote flexibility

Comprehensive benefits

Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a remote role with a Louisiana preference and Sunday–Thursday CST schedule. You will review plans, apply guidelines, coordinate decisions, and support discharge planning while ensuring appropriate, evidence-based care for members.

The role requires an active behavioral health license in Louisiana or a psychiatric RN with related experience, plus 3+ years of clinical practice and 1+ year EMR documentation.

Qualifications

• Active, unrestricted behavioral health license in Louisiana (LCSW, LCPC, LMFT, LPCC, LPAT, LPC) or Compact RN license with psychiatric experience.
• 3+ years of behavioral health clinical practice in settings like psychiatric hospital, residential treatment, or behavioral health treatment facilities.
• 1+ year of Electronic Medical Record (EMR) documentation experience.
• Ability to work Sunday–Thursday, 8:00 AM–5:00 PM CST, with flexibility for 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 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

Independent Behavioral Health license

RN license with psychiatric specialty

3+ years behavioral health clinical

EMR documentation

Sunday-Thursday CST availability

Education

Master's degree in Behavioral Health

Nursing degree (BSN)

Tools

EMR systems

Job description

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a remote role with a Louisiana preference and Sunday–Thursday CST schedule. You will review plans, apply guidelines, coordinate decisions, and support discharge planning while ensuring appropriate, evidence-based care for members.

The role requires an active behavioral health license in Louisiana or a psychiatric RN with related experience, plus 3+ years of clinical practice and 1+ year EMR documentation.