Utilization Management Clinical Consultant (Sunday Thursday)

CVS Health Corporation; Montpelier (VT); Remote; USD 54.000 - 117.000; Vollzeit

Zusammenfassung

CVS Health Corporation is seeking a Behavioral Health Utilization Management Clinician for remote work with a Louisiana preference. The role focuses on reviewing services, applying guidelines, and coordinating care to ensure medically necessary behavioral health treatment.

The position requires an active Louisiana behavioral health license and an unrestricted RN license with psychiatric experience, plus 3+ years of clinical practice and 1+ year EMR documentation experience.

Qualifikationen

• Active Louisiana behavioral health license (LCSW, LCPC, LMFT, LPCC, LPAT, LPC)
• Active, unrestricted Compact RN license with psychiatric specialty
• 3+ years behavioral health clinical practice experience
• 1+ year EMR documentation experience
• Sunday–Thursday, 8:00 AM–5:00 PM CST with possible weekends/holidays

Aufgaben

• Review behavioral health services and treatment plans to determine medical necessity and appropriateness of care
• Apply evidence-based guidelines and clinical best practices across levels of care
• Coordinate and communicate utilization management decisions with providers and care teams
• Provide triage support and crisis intervention as needed
• Facilitate discharge planning and transitions of care
• Identify members at risk and coordinate referrals to additional programs and services
• Promote quality and cost-effective utilization and outcomes
• Collaborate with internal and external stakeholders to support comprehensive care management

Kenntnisse

Behavioral health licensure

RN with psych specialty

EMR documentation

Clinical practice experience

Sunday-Thursday availability

Ausbildung

Master's degree (behavioral health)

Tools

EMR systems

Jobbeschreibung

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.

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 )
• 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

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 peopleWe 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.

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

We anticipate the application window for this opening will close on: 10/24/2026.