Remote Behavioral Health Utilization Specialist

CVS Health; Central City (CO); Remote; USD 54,000 - 143,000; Full time

Benefits offered by this job

Shift differential 12.5%

Remote nationwide role

Comprehensive benefits

Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a 100% remote nationwide role. This position emphasizes clinical decision-making, care coordination, and evidence-based preauthorization review.

Qualified candidates hold an independent behavioral health license in their state (LPC/LMHC/LCMHC or RN) and have 3+ years of post-licensure experience with mental health and substance use disorders.

Qualifications

• Active, unrestricted independent behavioral health clinical license in your state.
• Clinicians may hold LPC/LMHC/LCMHC or RN credentials.
• 3+ years post-licensure behavioral health experience.
• 3+ years experience with mental health and substance use disorders.
• Ability to effectively manage telephonic and computer-based work.
• Hospital-based behavioral health experience is a plus.
• Utilization Management or Prior Authorization experience.
• Managed Care experience.
• Fully remote position available anywhere in the U.S. with 12.5% shift differential.

Responsibilities

• Review preauthorization requests for behavioral health services using evidence-based guidelines and clinical judgment.
• Coordinate, document, and communicate utilization management decisions with providers and stakeholders.
• Handle crisis calls, assess risk, determine support needs, and coordinate interventions including escalation for suicide risk.
• Apply clinical expertise to support quality, cost-effective care and positive member outcomes.
• Work in a fast-paced, queue-based environment while managing multiple priorities.
• Collaborate with providers and care teams to facilitate appropriate levels of care.

Skills

License & independence

Telephonic work

Crisis management

Care coordination

Utilization management

Managed care

Education

Master's degree in Social Work/Counseling/Psychology

BSN with Behavioral Health emphasis (RN)

Job description

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a 100% remote nationwide role. This position emphasizes clinical decision-making, care coordination, and evidence-based preauthorization review.

Qualified candidates hold an independent behavioral health license in their state (LPC/LMHC/LCMHC or RN) and have 3+ years of post-licensure experience with mental health and substance use disorders.