Utilization Management Clinical Consultant – Behavioral Health

CVS Health

Remote Utilization Management Clinical Consultant role at CVS Health. Coordinating and administering behavioral health programs with flexibility in schedule and experience in Kentucky.

Posted 5/9/2026full-timeRemote • Kentucky • 🇺🇸 United StatesMid-LevelSenior💰 $26 - $56 per hourWebsite

About the role

Key responsibilities & impact

This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna Better Health of Kentucky.
The schedule is Monday-Friday, 8am-5pm with flexibility to work outside of the standard schedule based on business needs.
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

Kentucky Licensed Independent Behavioral Health Clinician (LPCC, LCSW, LMFT, LPAT) - OR - Active unrestricted Compact Registered Nurse (RN) license with psychiatric specialty or behavioral health experience
3+ years clinical practice experience in a behavioral health setting (e.g., psychiatric hospital, residential, or behavioral health treatment setting)
1+ year Electronic Medical Record documentation experience
Dedicated High Speed Internet Access
Master's Level of Education resulting in independent Behavioral Health licensure (LCSW, LPCC, LMFT, LPAT, LP, LBA) or an Associate's degree in Nursing with a KY or compact state Registered Nurse (RN) License with psychiatric specialty or behavioral health experience.
Experience with MS office applications including Teams, Outlook, Word, and Excel
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
comprehensive benefits package

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical skillscritical thinkingevidence-based caretreatment planningdischarge planningElectronic Medical Record documentationcomputer skillskeyboard skills

Soft Skills

collaborationcommunicationcrisis supportassessmentcoordinationquality improvement

Certifications

Kentucky Licensed Independent Behavioral Health ClinicianLCSWLPCCLMFTLPATRegistered Nurse (RN) license