Remote Utilization Management Clinician - Behavioral Health

CVS Health; New Jersey; Remote; USD 54,000 - 143,000; Full time

Benefits offered by this job

Shift differential 12.5%

Fully remote position

Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a 100% remote, nationwide role. You will review preauthorization requests, coordinate decisions with providers, and apply clinical judgment to ensure timely, appropriate behavioral health services while supporting positive member outcomes.

The position requires an active behavioral health license (LPC/LMHC/LCMHC or RN), 3+ years post-licensure in behavioral health, and experience with mental health and substance use

Qualifications

• Active, unrestricted independent behavioral health clinical license in your state of residence, including LPC/LMHC/LCMHC or RN.
• 3+ years of post-licensure behavioral health experience.
• 3+ years of experience working with mental health and substance use disorders.
• Ability to manage telephonic and computer-based work simultaneously.
• Hospital-based behavioral health experience.
• Utilization Management or Prior Authorization experience.
• Managed Care experience.
• Fully remote position available nationwide 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.
• Ability to manage crisis calls, apply clinical judgment to assess risk, determine support needs, and coordinate appropriate interventions, including escalation for suicide risk, self-harm concerns, and welfare checks when necessary.
• 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

LPC/LMHC/LCMHC

RN

Post-licensure experience

MH & SUD experience

Utilization Management experience

Managed Care experience

Crisis risk management

Telephonic work

Education

Master's degree in Social Work, Counseling, or Psychology

Bachelor's degree in Nursing with Behavioral Health emphasis

Job description

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a 100% remote, nationwide role. You will review preauthorization requests, coordinate decisions with providers, and apply clinical judgment to ensure timely, appropriate behavioral health services while supporting positive member outcomes.

The position requires an active behavioral health license (LPC/LMHC/LCMHC or RN), 3+ years post-licensure in behavioral health, and experience with mental health and substance use