[Hiring] Behavioral Health Clinical Consultant @CVS Health

Role Description

Fully remote role. Monday - Friday 8:30 - 5:00 pm EST. Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program for Medicare Integrated/dually eligible member populations. Applies critical thinking and clinical judgment grounded in evidence-based care and clinical practice guidelines for behavioral health and/or medical conditions, based on program focus. Supports care coordination and benefit management across complex member needs, with attention to quality, service, and appropriate resource use.

Key Responsibilities

• Apply clinical expertise to review and evaluate treatment plans across various levels of care, ensuring alignment with evidence-based standards, clinical guidelines, and applicable benefit coverage criteria.
• Coordinate, monitor, and assess healthcare service options to help ensure Medicare Integrated/dually eligible members receive appropriate, cost-effective care.
• Collect and assess clinical information to determine coverage recommendations, including discharge planning, transitions of care, and coordination of services for members with complex medical, behavioral health, and psychosocial needs.
• Collaborate with providers, care teams, and interdisciplinary partners to facilitate optimal treatment outcomes and support continuity of care.
• Identify high-risk members and connect them with appropriate internal programs, services, community resources, or additional supports.
• Recognize opportunities to enhance the quality and effectiveness of healthcare services while optimizing benefit use for a complex, high-need member population.
• Serve as a clinical resource to internal teams and external partners regarding utilization management processes, member needs, and coordination requirements.
• Perform responsibilities while working primarily at a computer, including extended periods of phone communication.

Qualifications

• Must be able to work the posted schedule. The role requires rendering decisions within mandated turnaround times; therefore, schedule flexibility is limited.
• Active, current, and unrestricted Master’s-level behavioral health clinical license in the state of residence (e.g., LMSW, LCSW, LISW, LPC, or comparable), or Registered Nurse licensure in the state of residence with psychiatric specialty, certification, or relevant experience.
• 1+ years of behavioral health utilization review/utilization management experience required.
• 3+ years of experience in an inpatient hospital setting working with behavioral health members. Experience must be recent, or supported by continuous, behavioral health-focused work since the inpatient setting experience.

Preferred Qualifications

• Experience working with Medicare, Medicaid, or dually eligible populations.
• Experience working with geriatric or chronically mentally ill populations.
• Experience supporting high-risk member populations.
• Strong computer proficiency, including navigating multiple systems and accurate keyboarding.

Education

• Master’s degree in a behavioral health field, or Registered Nurse degree (BSN preferred).

Anticipated Weekly Hours

• 40

Time Type

• Full time

Pay Range

The typical pay range for this role is: $26.01 - $68.55. 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.

Benefits

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
• Other resources, based on eligibility

Additional details about available benefits are provided during the application process.