Utilization Management Clinical Consultant (Sunday Thursday)

CVS Health; South Dakota; À distance; USD 54 000 - 117 000; Plein temps

Avantages offerts par ce poste

Bonus eligibility

Remote flexibility

Résumé du poste

CVS Health is seeking a licensed Behavioral Health Utilization Management Clinician to support members remotely, with a Louisiana preference. The role focuses on ensuring evidence-based behavioral health services, coordinating care, and guiding treatment planning.

Responsibilities include reviewing treatment plans, applying guidelines, triage and crisis support, discharge planning, and collaboration with care teams. Weekend/holiday flexibility may be required.

Qualifications

• Active, unrestricted Behavioral Health license in Louisiana (LCSW, LCPC, LMFT, LPCC, LPAT, LPC) or Compact RN with psychiatric specialty
• 3+ years of behavioral health clinical practice in settings such as psychiatric hospital or residential treatment
• 1+ year of EMR documentation experience
• Sunday–Thursday, 8:00 AM–5:00 PM CST with occasional weekends/holidays

Responsabilités

• Review behavioral health services and treatment plans to determine medical necessity
• 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 discharge planning and transitions of care
• Identify members at risk 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

Connaissances

Behavioral health license

Registered Nurse license

EMR experience

Clinical practice experience

EMR systems

Formation

Master's degree for BH clinicians

Nursing degree (BSN)

Outils

EMR systems

Description du poste

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.