Utilization Management Clinician - Independent Behavioral Health or Registered Nurse

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.

What You'll Do

• 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.

Required Qualifications

• 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);

Preferred Qualifications

• 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.

Education

• Master's degree in Behavioral/Mental Health, Human Services, or Health Services, or
• Associate's degree with RN license and 3+ years of behavioral health experience.

Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $66,575.00 - $142,576.00 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. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 06/07/2026 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 Apply To this Job