Behavioral Health Clinician - Utilization Management

CVS Health

1d • Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Behavioral Health Utilization Management Clinician (Work‑From‑Home | Monday–Friday) Schedule: Monday–Friday, Standard Business Hours (EST) Location: Work From Home No weekends. No holidays. About the Role We are seeking a highly skilled, detail‑oriented Behavioral Health Utilization Management Clinician to join our growing team. In this fully remote role, you will leverage your clinical expertise to support our utilization/benefit management program, ensuring members receive high‑quality, evidence‑based, and cost‑effective behavioral healthcare. This position is ideal for a clinician who excels in critical thinking, thrives in a structured environment, and is passionate about facilitating positive outcomes for members across diverse levels of care.

Requirements

• Active, current, and unrestricted Master's‑level Behavioral Health license in your state of residence (e.g., LMSW, LCSW, LISW, LPC, or comparable) OR Registered Nurse licensure with psychiatric specialty, certification, or experience.
• Ability to work Monday–Friday, Standard EST Business Hours (no evenings, weekends, or holidays).
• 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.

Nice To Haves

• Experience working with geriatric or chronically mentally ill populations.
• Experience supporting high‑risk or complex‑needs member populations.
• Strong computer proficiency, including navigating multiple systems simultaneously and accurate typing skills.

Responsibilities

• Apply clinical judgment to review and evaluate treatment plans across multiple levels of care, ensuring alignment with evidence‑based standards and clinical guidelines.
• Coordinate, monitor, and assess healthcare service options to ensure members receive appropriate, cost‑effective care.
• Gather and evaluate clinical information to inform coverage recommendations, including discharge planning and transitions of care.
• Collaborate with providers and interdisciplinary teams to support optimal treatment outcomes.
• Identify high‑risk members and connect them with internal programs or additional resources to support their care needs.
• Identify opportunities to improve care quality, service effectiveness, and benefit optimization.
• Act as a clinical resource for internal teams and external partners regarding utilization management processes.
• Perform responsibilities primarily through computer‑based work and extended periods of phone communication.
• Render clinical decisions within mandated turnaround times, requiring dependable, consistent availability during standard business hours.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level