Utilization Management Clinician - Independent Behavioral Health or Registered Nurse

CVS Health

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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 Position Summary 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. You’ll provide triage and crisis support when needed, identify members at risk for poor outcomes, and coordinate referrals to additional programs or services. You’ll also 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.

Requirements

• 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; accepted licenses include:
• Reliable residential broadband service (25 Mbps down / 3 Mbps up)

Nice To Haves

• 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.

Responsibilities

• Use clinical expertise to assess the appropriateness of treatment plans and levels of care.
• Apply evidence‑based guidelines, medical necessity criteria, and policy standards to coverage determinations.
• Coordinate, monitor, and evaluate options to support members in accessing appropriate healthcare services.
• Provide crisis intervention and triage support as needed.
• Facilitate effective discharge planning and transitions of care.
• Collaborate with providers and internal partners to ensure seamless, coordinated treatment.
• Identify at‑risk members and connect them with additional programs, services, or resources.
• Promote quality, efficiency, and appropriate utilization of benefits.
• Serve as a clinical resource for colleagues and partners involved in utilization and benefit management.

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