[Hiring] Utilization Management Clinician - Independent Behavioral Health or Registered Nurse @CVS Health

Role Description

Join a team that’s dedicated to helping individuals access the right care at the right time. As a Behavioral Health Utilization Management Clinician, you’ll use your clinical expertise and critical thinking skills to support members across the continuum of care. You’ll collaborate with providers, apply evidence‑based guidelines, and help ensure members receive clinically appropriate and cost‑effective treatment.

In this role, you will:

• Assess treatment plans across various levels of care.
• Evaluate medical necessity and make coverage recommendations using established criteria and clinical judgment.
• Provide triage and crisis support when needed.
• Identify members at risk for poor outcomes and coordinate referrals to additional programs or services.
• Partner with internal teams and external providers to promote high‑quality, effective healthcare and optimal benefit utilization.

This is a meaningful opportunity for clinicians who are passionate about improving patient outcomes while working in a fast‑paced, supportive environment.

Qualifications

• 3+ years of post‑degree experience in a psychiatric or substance abuse treatment setting.
• 3+ years of direct clinical practice experience post degree (e.g., hospital, ambulatory, or outpatient care).
• Active, unrestricted independent clinical behavioral health or registered nurse license in the state of residence.
• Reliable residential broadband service (25 Mbps down / 3 Mbps up).

Requirements

• 3+ years of managed care or utilization review experience.
• Strong crisis intervention skills.
• Proficiency navigating multiple computer systems and electronic platforms.
• California clinical license or willingness to obtain one.

Education

• Master’s degree in Behavioral/Mental Health, Human Services, or Health Services.
• Associate’s degree with RN license and 3+ years of behavioral health experience.

Benefits

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.