Utilization Management Nurse

Behavioral Health Utilization Management ClinicianWe'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.Are you a licensed Behavioral Health professional looking for a rewarding remote role that combines clinical expertise, critical thinking, and care coordination? Join our Utilization Management team and help ensure members receive timely, appropriate behavioral health services while making a meaningful impact on outcomes.Schedule:Saturday and Sunday 12pm-10pm MT (2pm-midnight EST)Thursday-Friday 3p-1am MT (5pm-3am EST)Must be available to work holidays10% shift differential includedWhat You'll Do:Review preauthorization requests for behavioral health services using evidence-based guidelines and clinical judgmentCoordinate, document, and communicate utilization management decisions with providers and stakeholdersAbility to manage crisis calls, apply clinical judgment to assess risk, determine support needs, and coordinate appropriate interventions, including escalation for suicide risk, self-harm concerns, and welfare checks when necessary.Apply clinical expertise to support quality, cost-effective care and positive member outcomesWork in a fast-paced, queue-based environment while managing multiple prioritiesCollaborate with providers and care teams to facilitate appropriate levels of careWhat You Bring - Required:Active, unrestricted independent behavioral health clinical license in your state of residence, including one of the following: LCSW, LICSW, LISW, LMSW, LPC, LMHC, LCMHC, LMFT, Clinical Psychologist, RN3+ years of post-licensure behavioral health experience3+ years of experience working with mental health and substance use disordersAbility to effectively manage telephonic and computer-based work simultaneouslyHigh-speed residential internet service (minimum 25 Mbps download / 3 Mbps upload)Preferred Qualifications:Hospital-based behavioral health experienceUtilization Management or Prior Authorization experienceManaged Care experienceEducation:Behavioral Health Clinicians: Master's degree in Social Work, Counseling, or PsychologyRegistered Nurses: Bachelor's degree in Nursing with an emphasis in Behavioral Health or PsychologyWhy Join Us?Fully remote position available anywhere in the U.S.Additional 10% shift differentialOpportunity to apply your clinical expertise in a non-traditional settingMeaningful work that improves access to quality behavioral health careCollaborative, mission-driven team environmentIf you're passionate about behavioral health, thrive in a fast-paced environment, and want to help members access the care they need, we'd love to hear from you. Apply today!Anticipated Weekly Hours: 40Time Type: Full timePay Range: The typical pay range for this role is: $54,095.00 - $142,576.00This 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.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 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.