About The Position
At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary Schedule: Monday–Friday, 8:00 AM–5:00 PM EST We are seeking a compassionate, clinically skilled professional to join our Utilization Management team. In this role, you will use your behavioral health or nursing expertise to support members in receiving high‑quality, evidence‑based care. You’ll play a vital part in evaluating treatment plans, coordinating services, and ensuring members receive the right care at the right time. This position is ideal for someone who enjoys clinical assessment, problem‑solving, and collaboration in a fast‑paced environment.
Requirements
- Candidates must meet one of the following criteria: Master’s‑level Behavioral Health clinical license, unencumbered and active in the state of residence (e.g., LMSW, LCSW, LISW, LPC, LMFT), OR Registered Nurse (RN) with an active license in the state of residence
- Additional requirements: 3+ years of behavioral health clinical experience in a hospital setting (required for both BH clinicians and RNs)
- 1+ year of utilization review or utilization management experience (e.g., concurrent review, pre‑certifications)
Nice To Haves
- 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
Responsibilities
- Apply clinical expertise to review and evaluate treatment plans across various levels of care, ensuring alignment with evidence‑based standards and clinical guidelines.
- Coordinate, monitor, and assess healthcare service options to ensure members receive appropriate and cost‑effective care.
- Provide clinical triage and crisis support as needed.
- Collect and assess clinical information to determine coverage recommendations, including discharge planning and transitions of care.
- Collaborate with providers and interdisciplinary teams to facilitate optimal treatment outcomes.
- Identify high‑risk members and connect them with appropriate internal programs, services, or additional supports.
- Recognize opportunities to enhance the quality and effectiveness of healthcare services while optimizing benefit use.
- Serve as a clinical resource to internal teams and external partners regarding utilization management processes.
- Perform responsibilities while working primarily at a computer with extended periods of phone communication.
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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
