[Hiring] Behavioral Health Utilization Management Clinician @CVS Health

Role Description

Are you a licensed Behavioral Health professional looking for a rewarding remote role that combines clinical expertise, critical thinking, and care coordination? Join our Utilization Management team and help ensure members receive timely, appropriate behavioral health services while making a meaningful impact on outcomes.

Schedule:

• Saturday and Sunday 12pm-10pm MT (2pm-midnight EST)
• Thursday-Friday 3p-1am MT (5pm-3am EST)
• Must be available to work holidays
• 10% shift differential included

What You'll Do:

• Review preauthorization requests for behavioral health services using evidence-based guidelines and clinical judgment.
• Coordinate, document, and communicate utilization management decisions with providers and stakeholders.
• Manage crisis calls, apply clinical judgment to assess risk, determine support needs, and coordinate appropriate interventions, including escalation for suicide risk, self-harm concerns, and welfare checks when necessary.
• Apply clinical expertise to support quality, cost-effective care and positive member outcomes.
• Work in a fast-paced, queue-based environment while managing multiple priorities.
• Collaborate with providers and care teams to facilitate appropriate levels of care.

Qualifications

• Active, unrestricted independent behavioral health clinical license in your state of residence, including one of the following:
  • LCSW, LICSW, LISW, LMSW
  • LPC, LMHC, LCMHC
  • LMFT
  • Clinical Psychologist
  • RN
• 3+ years of post-licensure behavioral health experience.
• 3+ years of experience working with mental health and substance use disorders.
• Ability to effectively manage telephonic and computer-based work simultaneously.
• High-speed residential internet service (minimum 25 Mbps download / 3 Mbps upload).

Requirements

• Hospital-based behavioral health experience (preferred).
• Utilization Management or Prior Authorization experience (preferred).
• Managed Care experience (preferred).

Education

• Behavioral Health Clinicians: Master's degree in Social Work, Counseling, or Psychology.
• Registered Nurses: Bachelor's degree in Nursing with an emphasis in Behavioral Health or Psychology.

Benefits

• Fully remote position available anywhere in the U.S.
• 10% shift differential.
• Opportunity to apply your clinical expertise in a non-traditional setting.
• Meaningful work that improves access to quality behavioral health care.
• Collaborative, mission-driven team environment.