Behavioral Health Clinical Consultant

Job not on LinkedIn

🔥 5 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $26 - $68 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Coordinate, document, and communicate utilization and benefit management for Medicare Integrated/dually eligible members • Review and evaluate treatment plans across levels of care against evidence-based standards, clinical guidelines, and benefit coverage criteria • Coordinate, monitor, and assess healthcare service options to support appropriate, cost-effective care • Collect and assess clinical information for coverage recommendations, discharge planning, transitions of care, and service coordination • Collaborate with providers, care teams, and interdisciplinary partners to support treatment outcomes and continuity of care • Identify high-risk members and connect them with internal programs, community resources, and additional supports • Identify opportunities to improve healthcare quality and effectiveness while optimizing benefit use • Serve as a clinical resource to internal teams and external partners regarding utilization management and member coordination • Work primarily at a computer, including extended periods of phone communication

🎯 Requirements

• Must be able to work Monday–Friday, 8:30 am–5:00 pm EST, with limited schedule flexibility • Active, current, and unrestricted Master’s-level behavioral health clinical license in the state of residence (e.g., LMSW, LCSW, LISW, LPC, or comparable), or Registered Nurse licensure in the state of residence with psychiatric specialty, certification, or relevant experience • 1+ years of behavioral health utilization review/utilization management experience • 3+ years of experience in an inpatient hospital setting working with behavioral health members • Inpatient behavioral health experience must be recent or supported by continuous behavioral health-focused work • Experience with Medicare, Medicaid, or dually eligible populations preferred • Experience with geriatric or chronically mentally ill populations preferred • Experience supporting high-risk member populations preferred • Strong computer proficiency, including navigating multiple systems and accurate keyboarding preferred • Master’s degree in a behavioral health field, or Registered Nurse degree; BSN preferred

🏖️ Benefits

• 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 in addition to base pay

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