Behavioral Health Utilization Management Clinical Consultant - Work at Home - Oklahoma

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.

Work at home Position-Must Reside in Oklahoma Position Summary: Behavioral Health Clinical Reviewer (LCSW, LCPC, RN) Licensed clinical professional with a passion for behavioral health and a strong background in psychiatric care. As a Behavioral Health Clinical Reviewer, your expertise will drive impactful decisions that improve lives. In this role, you’ll leverage your clinical skills to coordinate, document, and communicate all aspects of our utilization and benefit management programs. You’ll apply critical thinking and evidence-based guidelines to assess treatment plans, ensure appropriate levels of care, and promote quality healthcare outcomes.

Evaluate treatment plans using clinical judgment and evidence-based standards. Coordinate and monitor healthcare services to ensure optimal benefit utilization. Provide triage and crisis support for members in need. Facilitate effective discharge planning and care transitions. Collaborate with providers and internal teams to support integrated care. Identify at-risk members and connect them with appropriate resources. Promote quality and cost-effective care through clinical consultation and review.