Utilization Management Clinical Consultant (BH) (Tuesday - Saturday)

CVS Health; United States; Remote; USD 36,000 - 77,000; Full time

Benefits offered by this job

Health benefits

Dental benefits

Vision benefits

Retirement plan

Wellness program

Job summary

CVS Health is seeking an Utilization Management Clinical Consultant for a Work at Home CST role. You will apply clinical experience to assess treatment plans, coordinate care, and render coverage determinations across the continuum of care, with a focus on quality and safety.

This full-time position requires an independent Behavioral Health license (LA or Compact), 3+ years in behavioral health, and EMR documentation experience. Schedule Tue-Sat with flexible hours; annual pay range listed.

Qualifications

• Independent Behavioral Health clinician license in LA or Compact
• 3+ years clinical practice in behavioral health settings
• 1+ year EMR documentation experience

Responsibilities

• Assess and render coverage determinations across levels of care using evidence-based guidelines.
• Coordinate and monitor treatment options to optimize member care and benefit utilization.
• Provide triage and crisis support as part of utilization management.
• Consult with providers and internal/external stakeholders to facilitate appropriate care and discharge planning.
• Identify opportunities to promote quality and effectiveness of healthcare services.

Skills

Clinical assessment

Crisis triage

Care coordination

Multitasking

Education

Master's Degree in Behavioral Health licensure (LCSW/LPCC/LMFT/LP/LPAT)

Tools

EMR documentation

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.

Utilization Management Clinical Consultant

Location: Work at Home CST

Travel: None

Schedule: Tuesday-Saturday with flexibility to work outside of the standard schedule based on business needs

Position summary:

In this role you will be utilizing clinical experience and skills in a collaborative process to assess appropriate treatment plans across levels of care. Applying evidence-based standards and practice guidelines to treatment where appropriate. Coordinating, monitoring, and evaluating options to facilitate appropriate healthcare services/benefits for members. Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services, and/or programs. Providing triage and crisis support. Gathers clinical information and applying 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. You will also be coordinating with providers and other parties to facilitate optimal care/treatment. 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:

• Independent Behavioral Health clinician License either within the state of LA or Compact 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.

Preferred Qualifications:

• Preference to candidates who reside 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.

High level of technical skills

Education:

Master's Level of Education resulting in independent Behavioral Health licensure (LCSW, LPCC, LMFT, LPAT, LP) 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.

We anticipate the application window for this opening will close on: 10/31/2026

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