Utilization Management Clinician Behavioral Health

CVS Health; United States; Remote; USD 54,000 - 156,000; Full time

Job summary

A leading healthcare solutions company is seeking a skilled professional for a fully remote clinical role focusing on utilization/benefit management. The position requires a valid Behavioral Health clinical license and offers opportunities to coordinate comprehensive patient care. The successful candidate will work collaboratively with healthcare providers and leverage their clinical expertise to assist members, ensuring effective treatment pathways and quality healthcare delivery.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings and counseling programs

Flexible work schedules

Tuition assistance

Qualifications

• Must have an active and unrestricted Master's Level Behavioral Health clinical license in the state of residence.
• 1+ years of utilization review/utilization management required.
• 3+ years of behavioral health clinical experience in a hospital setting.

Responsibilities

• Utilizes clinical skills for benefit management program coordination.
• Assesses appropriateness of treatment plans and provides crisis reports.
• Coordinates with providers to facilitate optimal care.

Skills

Clinical judgment

Crisis intervention

Collaboration

Education

Master's degree in Behavioral/Mental Health or Human Services

Tools

Computer proficiency

Job description

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary
Fully remote role.
Monday-Friday 8:30-5pm EST. No weekends or holidays.

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care an clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.

• Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guideline to treatment where appropriate.
• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Provides triage and crisis report.
• Gathers clinical information and applies the appropriate clinical judgment to render coverage determination/recommendation along the continuum of care facilities including effective discharge planning.
• Coordinates with providers and other parties to facilitate optimal care/treatment.
• Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• Work requires sitting for extended periods, talking on the telephone and typing on the computer.

Required Qualifications

• Must have active current and unrestricted Master's Level Behavioral Health clinical license in the state of residence (LMSW, LCSW, LISW, LPC, or comparable) or Registered Nurse licensure with psychiatric specialty, certification, or experience in state of residence.
• Must be able to work Monday through Friday 8:30-5pm EST. No weekends or holidays.
• 1+ years of utilization review/utilization management required.
• 3+ years of behavioral health clinical experience in a hospital setting.

Preferred Qualifications

• Experience working with geriatric population.
• Crisis intervention skills preferred.
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
• Managed care preferred.

Education

• Unencumbered Behavioral Health clinical license in the state where they work.
• Minimum of Master's degree in Behavioral/Mental Health or Human Service/Health services or Registered Nurse with Behavioral Health experience/background.

Anticipated Weekly Hours

40

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary
Fully remote role.
Monday-Friday 8:30-5pm EST. No weekends or holidays.

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care an clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.

• Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guideline to treatment where appropriate.
• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Provides triage and crisis report.
• Gathers clinical information and applies the appropriate clinical judgment to render coverage determination/recommendation along the continuum of care facilities including effective discharge planning.
• Coordinates with providers and other parties to facilitate optimal care/treatment.
• Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• Work requires sitting for extended periods, talking on the telephone and typing on the computer.

Required Qualifications

• Must have active current and unrestricted Master's Level Behavioral Health clinical license in the state of residence (LMSW, LCSW, LISW, LPC, or comparable) or Registered Nurse licensure with psychiatric specialty, certification, or experience in state of residence.
• Must be able to work Monday through Friday 8:30-5pm EST. No weekends or holidays.
• 1+ years of utilization review/utilization management required.
• 3+ years of behavioral health clinical experience in a hospital setting.

Preferred Qualifications

• Experience working with geriatric population.
• Crisis intervention skills preferred.
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
• Managed care preferred.

Education

• Unencumbered Behavioral Health clinical license in the state where they work.
• Minimum of Master's degree in Behavioral/Mental Health or Human Service/Health services or Registered Nurse with Behavioral Health experience/background.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $155,538.00

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 07/05/2025

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

About the company

At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans and community pharmacists, we’re pioneering a bold new approach to total health. Making quality care more affordable, accessible, simple and seamless, to not only help people get well, but help them stay well in body, mind and spirit.

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