Utilization Management Clinical Consultant (Sunday Thursday)

CVS Health; Elm (PA); Remote; USD 36,000 - 77,000; Full time

Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a remote role with a Louisiana preference and a Sunday–Thursday schedule. You will review services for medical necessity, coordinate decisions with care teams, and support crisis intervention and discharge planning to improve member outcomes.

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

Qualifications

• Active, unrestricted independent Behavioral Health license in Louisiana (LCSW, LCPC, LMFT, LPCC, LPAT, LPC) or
• Active, unrestricted Compact RN license with psychiatric specialty experience
• 3+ years of behavioral health clinical practice experience in settings such as psychiatric hospital or behavioral health treatment
• Master's degree required for independently licensed Behavioral Health clinicians
• Registered Nurse with psychiatric specialty experience and unrestricted nursing license also considered (Bachelor’s Degree in Nursing)
• Experience with Managed Care, Utilization Review, or Utilization Management
• Ability to work Sunday - Thursday, 8:00 AM - 5:00 PM CST with flexibility for weekends/holidays
• Opportunity to improve behavioral health outcomes across continuum of care
• Remote flexibility with a supportive team culture

Responsibilities

• Review behavioral health services and treatment plans to determine medical necessity and appropriateness 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 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

Behavioral health experience

EMR documentation

Discharge planning

Crisis intervention

Utilization management

Education

Master's degree in Behavioral Health

RN with psychiatric specialty (optional)

Bachelor’s Degree in Nursing

Tools

EMR systems

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. Behavioral Health Utilization Management Clinician

Remote | Louisiana Preferred | Sunday - Thursday Schedule

Are you a licensed Behavioral Health professional or Psychiatric RN looking to make a meaningful impact on members' mental health outcomes? Join our Utilization Management team and play a critical role in ensuring members receive appropriate, evidence-based behavioral health services while supporting quality care and effective treatment planning.

• Review behavioral health services and treatment plans to determine medical necessity and appropriateness 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

• Active, unrestricted independent Behavioral Health license in Louisiana ( LCSW, LCPC, LMFT, LPCC, LPAT, LPC ) or
• ~ Active, unrestricted Compact RN license with psychiatric specialty experience
• ~3+ years of behavioral health clinical practice experience, such as:
• ~ Psychiatric hospital
• ~ Behavioral health treatment settings
• ~1+ year of Electronic Medical Record (EMR) documentation experience
• ~ Ability to work Sunday - Thursday, 8:00 AM - 5:00 PM Central Standard Time (CST), with flexibility for occasional weekends and holidays
• Managed Care, Utilization Review, or Utilization Management experience
• Behavioral health inpatient experience
• Proficiency navigating multiple systems and applications in a fast-paced environment
• Master's degree required for independently licensed Behavioral Health clinicians
• Registered Nurse with psychiatric specialty experience and unrestricted nursing license also considered (Bachelor’s Degree in Nursing)
• Opportunity to improve behavioral health outcomes for members across the continuum of care
• Influence quality, access, and effectiveness of behavioral health services
• Remote flexibility with a supportive team culture

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. 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 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.

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: 10/24/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.