Utilization Management Clinician - Independent Behavioral Health or Registered Nurse

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. Behavioral Health Utilization Management Clinician Position Summary Join a team that’s dedicated to helping individuals access the right care at the right time. As a Behavioral Health Utilization Management Clinician, you’ll use your clinical expertise and critical thinking skills to support members across the continuum of care. You’ll collaborate with providers, apply evidence‑based guidelines, and help ensure members receive clinically appropriate and cost‑effective treatment. In this role, you will assess treatment plans across various levels of care, evaluate medical necessity, and make coverage recommendations using established criteria and clinical judgment. You’ll provide triage and crisis support when needed, identify members at risk for poor outcomes, and coordinate referrals to additional programs or services. You’ll also partner with internal teams and external providers to promote high‑quality, effective healthcare and optimal benefit utilization. This is a meaningful opportunity for clinicians who are passionate about improving patient outcomes while working in a fast‑paced, supportive environment. What You’ll Do Use clinical expertise to assess the appropriateness of treatment plans and levels of care. Apply evidence‑based guidelines, medical necessity criteria, and policy standards to coverage determinations. Coordinate, monitor, and evaluate options to support members in accessing appropriate healthcare services. Provide crisis intervention and triage support as needed. Facilitate effective discharge planning and tr...