Utilization Management Clinical Consultant – Behavioral Health

CVS Health

Utilization Management Clinical Consultant managing behavioral health services at CVS Health. Collaborating with providers to ensure quality and appropriate healthcare services for members.

Posted 5/6/2026full-timeRemote • Kentucky • 🇺🇸 United StatesMid-LevelSenior💰 $26 - $56 per hourWebsite

About the role

Key responsibilities & impact

Coordinate, document and communicate all aspects of the utilization/benefit management program
Utilize clinical skills to assess appropriateness of treatment plans across levels of care
Gathers clinical information and applies the appropriate clinical criteria/guideline to render coverage determinations
Provides triage and crisis support
Identify members at risk for poor outcomes and facilitate referral opportunities

Requirements

What you’ll need

Kentucky Licensed Independent Behavioral Health Clinician ( LPCC, LCSW, LMFT, LPAT )
Active unrestricted Compact Registered Nurse (RN) license with psychiatric specialty or behavioral health experience
3+ years clinical practice experience in a behavioral health setting
1+ year Electronic Medical Record documentation experience
Dedicated High Speed Internet Access
Preferred Qualifications: Residency in Kentucky or bordering counties
Experience working with Substance Use Disorder diagnoses
Managed care/utilization review experience
Medicaid experience
Proficiency with computer skills

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
other resources, based on eligibility

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical assessmenttreatment planningcoverage determinationstriage supportcrisis supportElectronic Medical Record documentationSubstance Use Disorder experiencemanaged care experienceutilization review experiencebehavioral health experience

Soft Skills

communicationcoordinationdocumentationinterpersonal skillsorganizational skills

Certifications

Kentucky Licensed Independent Behavioral Health ClinicianRegistered Nurse license