Utilization Management Clinical Consultant (Sunday Thursday)

CVS Health; Nebraska; Remoto; USD 54.000 - 117.000; Tempo pieno

Vantaggi offerti da questo lavoro

Remote flexibility

Comprehensive benefits

Descrizione del lavoro

CVS Health is seeking a Behavioral Health Utilization Management Clinician to join our remote team. This role supports members' mental health outcomes by evaluating services for medical necessity, applying evidence-based guidelines, and coordinating care with providers and care teams.

The position emphasizes crisis intervention, discharge planning, and collaboration across departments. Ideal candidates will have an active behavioral health license (Louisiana preferred) or a psychiatric RN with

Competenze

• Licensed behavioral health professional with active, unrestricted license (Louisiana or compact RN with psych experience).
• 3+ years behavioral health clinical practice in hospital, residential, or related settings.
• 1+ year EMR documentation experience.

Mansioni

• Review behavioral health services and treatment plans for medical necessity.
• Apply guidelines and best practices across levels of care.
• Coordinate utilization management decisions with providers and care teams.
• Provide triage support and crisis intervention as needed.
• Discharge planning and transitions of care.

Conoscenze

Clinical expertise

Crisis intervention

Team communication

EMR documentation

Scheduling flexibility

Formazione

Master's degree

RN with psych specialty

Strumenti

EMR systems

Descrizione del lavoro

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.

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 (Bachelors 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.