Utilization Management Clinical Consultant – Monday - Friday

CVS Health

Clinical Consultant at CVS Health utilizing skills in healthcare benefit management and evidence-based care. Coordinating, documenting, and communicating healthcare services for members.

Posted 4/28/2026full-timeRemote • Louisiana • 🇺🇸 United StatesMid-LevelSenior💰 $26 - $56 per hourWebsite

About the role

Key responsibilities & impact

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 and 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 guidelines to treatment where appropriate.
Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
Provides triage and crisis support.
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates 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.

Requirements

What you’ll need

Licensed independent Behavioral Health clinician (i.e. LCSW, LCPC, LMFT, LPCC, LPAT, LPC) in state of Louisiana or a Registered Nurse (RN) with unrestricted compact state license with psychiatric specialty experience.
3 years clinical practice experience, e.g., psychiatric hospital, residential or behavioral health treatment setting.
1 year Electronic Medical Record documentation experience.
Must be able to work Monday through Friday, 8:00 AM to 5:00 PM Central Standard Time (CST) zone with flexibility to work outside of the standard schedule based on business needs, including occasional rotating weekend and holiday schedules.

Benefits

Comp & perks

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

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

clinical skillscritical thinkingevidence based caretreatment planningdischarge planningcoverage determinationclinical judgmenttriage supportcrisis supportdocumentation

Soft Skills

collaborationcommunicationassessmentcoordinationproblem solvingquality improvementflexibilityconsultationinterpersonal skillsorganizational skills

Certifications

LCSWLCPCLMFTLPCCLPATLPCRegistered Nurse (RN)