Utilization Management Clinical Consultant (Sunday Thursday)

4062 Aetna Resources, LLC; Louisiana (MO); Hybrid; USD 74,473,000 - 161,033,000; Full time

Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a remote Louisiana-based role with a Sunday through Thursday schedule. You will review services for medical necessity, apply evidence-based guidelines, and coordinate utilization decisions with care teams across multiple levels of care.

The position requires an active Louisiana Behavioral Health license or psychiatric RN with 3+ years of clinical experience and EMR documentation experience, plus flexibility for

Qualifications

• Active, unrestricted Louisiana Behavioral Health license (LCSW, LCPC, LMFT, LPCC, LPAT, LPC) or active unrestricted Compact RN with psych experience.
• 3+ years of behavioral health clinical practice experience.
• 1+ year of EMR documentation experience.
• Ability to work Sunday-Thursday, 8:00 AM–5:00 PM CST, with occasional weekend/holiday flexibility.

Responsibilities

• Review behavioral health services to determine medical necessity and appropriateness of care.
• Apply evidence-based guidelines across multiple levels of care.
• Coordinate utilization decisions with providers and care teams.
• Provide triage support and crisis intervention as needed.
• Facilitate discharge planning and transitions of care.
• Identify at-risk members and coordinate referrals to programs.
• Promote quality, cost-effective healthcare utilization and positive outcomes.
• Collaborate with stakeholders to support comprehensive care management.

Skills

EMR documentation

Behavioral Health licensure

Psychiatric RN option

Education

Master's degree required for independently licensed Behavioral Health clinicians

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

What You’ll Do

• Review behavioral health services and treatment plans to determine medical necessity and appropriateness of care
• Apply evidence-based guidelines and clinical best practices across multiple levels 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

What You Bring – REQUIRED

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
• Residential treatment
• 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

Preferred Qualifications

• Louisiana residency strongly preferred
• Managed Care, Utilization Review, or Utilization Management experience
• Behavioral health inpatient experience
• Licensed Addiction Counselor (LAC) certification
• Strong multitasking, prioritization, and organizational skills
• Proficiency navigating multiple systems and applications in a fast-paced environment
• Education 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)

Why Join Us?

Opportunity to improve behavioral health outcomes for members across the continuum of care Collaborative environment with providers, care managers, and clinical experts Apply your clinical expertise in a meaningful, non-traditional care setting Influence quality, access, and effectiveness of behavioral health services Remote flexibility with a supportive team culture

If you're passionate about behavioral health, utilization management, and helping members access the right level of care at the right time, we'd love to hear from you.

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: 10/24/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.