Utilization Management Clinician - Behavioral Health - Work at Home

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 - Work schedule is Mon-Fri 8-5 EST 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 an 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, apply evidence based standards and practice guideline to treatment where appropriate. - Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. - Provides triage and crisis report. - Gathers clinical information and applies the appropriate clinical judgment to render coverage determination/recommendation along the continuum of care facilities 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. - Work requires sitting for extended periods, talking on the telephone and typing on the computer. Required Qualifications - One of the following is required: Unencumbered Master's Level Behavioral Health clinical license in the state where they work (LMSW, LCSW, LISW, LPC, LMFT etc.) or Registered Nurse in state of residence -3+ years of behavioral health clinical experience in a hospital setting required for either BH or RN -1+ years of utilization review/utilization management required (i.e.. concurrent review, pre-certifications) for BH or RN Preferred Qualifications -Experience working with geriatric population and chronically mentally ill population - Experience with High Risk members - Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Education Master's degree social worker, MSW, LCSW, Behavioral /mental health services or Registered Nurse with Behavioral Health experience/background Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 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. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: • 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. For more information, visit We anticipate the application window for this opening will close on: 12/17/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply tot his job