Utilization Management Clinical Consultant – Tuesday - Saturday

CVS Health

. Coordinate, document, and communicate all aspects of the utilization and benefit management program .

Posted 10/5/2026full-timeRemote • United StatesMid-LevelSenior💰 $26 - $56 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Behavioral Health coordination, clinical assessment, and utilization management, with a strong focus on evidence-based care and effective communication with healthcare providers. Proficient in Electronic Medical Record documentation and crisis support within psychiatric settings.

Highest-signal resume keywords

LCSW LicenseLCPC LicenseRegistered Nurse LicenseClinical Practice ExperienceElectronic Medical Record Documentation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentUtilization ManagementCrisis SupportDischarge PlanningBehavioral Health TreatmentEvidence-Based CareTreatment Plan AppropriatenessHealthcare Services CoordinationQuality ImprovementTriage

Soft Skills

Critical ThinkingCommunicationCollaborationFlexibilityProblem Solving

Tools & Technologies

Electronic Medical Record SystemsComputer Proficiency

Certifications & Qualifications

LCSWLCPCRegistered Nurse License

Industry Keywords

Behavioral HealthManaged CareUtilization ReviewPsychiatric SettingClinical Practice Guidelines

About the role

Key responsibilities & impact

Coordinate, document, and communicate all aspects of the utilization and benefit management program
Apply critical thinking, evidence-based care, clinical practice guidelines, policies, procedures, and clinical judgment to Behavioral Health and/or medical conditions
Assess treatment-plan appropriateness across levels of care
Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits
Provide triage and crisis support
Gather clinical information and render coverage determinations or recommendations across the continuum of care
Facilitate effective discharge planning
Coordinate with providers and other parties to facilitate optimal care and treatment
Identify members at risk for poor outcomes and facilitate referrals to integrated products, services, and programs
Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization
Consult with internal and external constituents on utilization and benefit management coordination and administration

Requirements

What you’ll need

LCSW, LCPC, or RN with experience in a psychiatric setting required
Independent Behavioral Health clinician license or unrestricted Registered Nurse (RN) license within Louisiana or compacted, with psychiatric specialty experience
3+ years of clinical practice experience, such as psychiatric hospital, residential, or behavioral health treatment setting
1+ year of Electronic Medical Record documentation experience
Reliable high-speed internet access
Flexibility to work Tuesday–Saturday, 8am–5pm CST, outside standard hours as needed, including occasional rotating weekend and holiday schedules
Master's-level education resulting in independent Behavioral Health licensure, or bachelor's-level education resulting in an RN with an unrestricted state license and psychiatric specialty experience
Computer proficiency, including navigating multiple systems and keyboarding
Managed care/utilization review experience preferred
Experience in a behavioral health inpatient setting preferred

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
CVS Health bonus, commission or short-term incentive program eligibility