[Hiring] Utilization Management - Behavioral Health Clinician @CVS Health

Role Description

The Behavioral Health UM Clinician position is designed to clinically review behavioral health prior authorized services for assigned members. This position’s responsibilities shall include, but are not limited to the following:

• 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, and 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, applying evidence-based standards and practice guidelines to treatment where appropriate.
• Coordinates, monitors and evaluates options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care, 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.

Qualifications

• Active, current, and unrestricted Master's-level Behavioral Health license in OHIO (e.g., LISW, LPC, or comparable) OR Registered Nurse licensure in OHIO with psychiatric specialty, certification, or experience.
• 1+ years of Utilization Review/Utilization Management experience required.
• 3+ years of Behavioral Health clinical experience in a hospital setting.
• Recent experience in an inpatient hospital behavioral health setting, or continuous, recent behavioral-health-focused work since that experience.
• Ability to meet mandated decision turnaround times with limited schedule flexibility.
• Must possess reliable transportation and be willing and able to travel up to 10% of the time. Mileage is reimbursed per our company expense reimbursement policy.

Preferred Qualifications

• UM experience with members/children 0-21.

Education

• Master’s degree in a Behavioral Health discipline OR Associate Degree in Nursing (ADN) with Behavioral Health experience. BSN preferred.

Anticipated Weekly Hours

• 40

Time Type

• Full time

Pay Range

The typical pay range for this role is: $29.10 - $62.32. 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

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.

Application Information

We anticipate the application window for this opening will close on: 06/30/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.