Utilization Management Clinician - Behavioral Health or Registered Nurse

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Schedule: Monday–Friday, 8:00 AM–5:00 PM EST

We are seeking a compassionate, clinically skilled professional to join our Utilization Management team. In this role, you will use your behavioral health or nursing expertise to support members in receiving high‑quality, evidence‑based care. You’ll play a vital part in evaluating treatment plans, coordinating services, and ensuring members receive the right care at the right time. This position is ideal for someone who enjoys clinical assessment, problem‑solving, and collaboration in a fast‑paced environment.

Key Responsibilities

• Apply clinical expertise to review and evaluate treatment plans across various levels of care, ensuring alignment with evidence‑based standards and clinical guidelines.
• Coordinate, monitor, and assess healthcare service options to ensure members receive appropriate and cost‑effective care.
• Provide clinical triage and crisis support as needed.
• Collect and assess clinical information to determine coverage recommendations, including discharge planning and transitions of care.
• Collaborate with providers and interdisciplinary teams to facilitate optimal treatment outcomes.
• Identify high‑risk members and connect them with appropriate internal programs, services, or additional supports.
• Recognize opportunities to enhance the quality and effectiveness of healthcare services while optimizing benefit use.
• Serve as a clinical resource to internal teams and external partners regarding utilization management processes.
• Perform responsibilities while working primarily at a computer with extended periods of phone communication.

Required Qualifications

Candidates must meet one of the following criteria:

• Master’s‑level Behavioral Health clinical license, unencumbered and active in the state of residence (e.g., LMSW, LCSW, LISW, LPC, LMFT),
  OR
• Registered Nurse (RN) with an active license in the state of residence

Additional requirements:

• 3+ years of behavioral health clinical experience in a hospital setting (required for both BH clinicians and RNs)
• 1+ year of utilization review or utilization management experience (e.g., concurrent review, pre‑certifications)

Preferred Qualifications

• Experience working with geriatric or chronically mentally ill populations
• Experience supporting high‑risk member populations
• Strong computer proficiency, including navigating multiple systems and accurate keyboarding

Education

• Master’s degree in Social Work (MSW), LCSW, or related behavioral/mental health field
  OR
• Registered Nurse with behavioral health experience or background

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,522.00 - $129,615.00

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cess