Utilization Management - Behavioral Health Clinician - Must Reside in Ohio

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Behavioral Health UM Clinician position is designed to clinically review of behavioral health prior authorized services for assigned members. This position’s responsibilities shall include, but are not limited to the following: 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. 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. Required Qualifications Active, current, and unrestricted Master's‑level Behavioral Health license in OHIO, (e.g., LISW, LPC, or comparable) OR Registered Nurse licensure in OHIO with psychiatric specialty, certification, or experience 1+ years of Utilization Review/Utilization Management experience required. 3+ years of Behavioral Health clinical experience in a hospital setting. Recent experience in an inpatient hospital behavioral health setting, or continuous, recent behavioral‑health‑focused work since that experience. Ability to meet mandated decision turnaround times with limited schedule flexibility. Must possess reliable transportation and be willing and able to travel up to 10% of the time. Mileage is reimbursed per our company expense reimbursement policy. Preferred Qualifications UM experience with members/children 0-21 Education Master’s degree in a Behavioral Health discipline OR Associate Degree in Nursing (ADN) with Behavioral Health experience BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range Typical pay range for this role is $29.10 - $62.32 per hour. 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: 06/30/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr CVS Health