Utilization Management Clinical Consultant

CVS Health Corporation; Louisiana (MO); Hybrid; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation is seeking an experienced Behavioral Health clinician to coordinate utilization and benefit management. The role involves applying evidence-based guidelines, triage support, and coordinating with providers to ensure optimal care for members.

Ideal candidates hold a licensed independent Behavioral Health credential or RN with psychiatric specialty, with 3 years of clinical practice and EMR experience. Typical hours are M–F, CST, with potential weekend/holiday scheduling.

Qualifications

• Licensed independent Behavioral Health clinician in Louisiana or RN with psychiatric specialty.
• 3 years clinical practice experience in psychiatric/h behavioral health settings.
• 1 year EMR documentation experience.
• Must be able to work Monday–Friday 8:00 AM–5:00 PM CST with flexibility for nonstandard hours including weekends/holidays.

Responsibilities

• Utilizes clinical skills to coordinate, document and communicate utilization/benefit management.
• Applies evidence-based care and guidelines for Behavioral Health and/or medical conditions.
• Assesses appropriateness of treatment plans and applies clinical criteria across care levels.
• Coordinates, monitors and evaluates options to facilitate appropriate healthcare services for members.
• Provides triage and crisis support.
• Gathers clinical information to render coverage determinations/recommendations.
• Coordinates with providers to enable optimal care and treatment.
• Identifies at-risk members and facilitates referrals to integrate with other programs.
• Explores opportunities to improve quality and effectiveness of healthcare services.
• Consults with internal/external stakeholders in utilization/benefit management.

Skills

Clinical coordination

Crisis management

Evidence-based practice

Communication

Education

Master's degree in Behavioral Health or RN with psychiatric specialty

Tools

Electronic Medical Records (EMR)

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

• Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.

• Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.

• Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guidelines to treatment where appropriate.

• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

• Provides triage and crisis support.

• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage. determination/recommendation along the continuum of care facilitates including effective discharge planning.

• Coordinates with providers and other parties to facilitate optimal care/treatment.

• Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.

• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.

• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Required Qualifications

• Licensed independent Behavioral Health clinician (i.e. LCSW, LCPC, LMFT, LPCC, LPAT, LPC) in state of Louisiana or a Registered Nurse (RN) with unrestricted compact state license with psychiatric specialty experience.

• 3 years clinical practice experience, e.g., psychiatric hospital, residential or behavioral health treatment setting.
• 1 year Electronic Medical Record documentation experience.
• Must be able to work Monday through Friday, 8:00 AM to 5:00 PM Central Standard Time (CST) zone with flexibility to work outside of the standard schedule based on business needs, including occasional rotating weekend and holiday schedules.

Preferred Qualifications

• Strongly prefer someone who resides in Louisiana.
• Managed care/utilization review experience preferred.

Experience in a behavioral health inpatient setting.

• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.

• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.

• LAC (Licensed Addiction Counselor) preferred.

Education

• Master's Level of Education resulting in independent Behavioral Health licensure (LCSW, LCPC, LMFT, LPCC, LPAT, LPC) or a Registered Nurse (RN) with unrestricted state license with psychiatric specialty experience.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $56.14

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 09/30/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.