Utilization Management Clinician Behavioral Health

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.

UM Clinician - Behavioral Health (Aetna Student Health)

Make an impact on student mental health through clinical expertise and care coordination. Join the Aetna Student Health Behavioral Health team and play a key role in ensuring members receive appropriate, high-quality behavioral health services through effective utilization management.

What You'll Do

• Provides high-level scope of role and leadership in the utilization management process for behavioral health services, ensuring effective and appropriate utilization of resources.
• Conducts comprehensive assessments and evaluations of members' behavioral health needs, utilizing evidence-based criteria and clinical expertise to determine the most appropriate level of care and treatment options.
• Supports the core purpose of the job by collaborating with providers, members, and multidisciplinary teams to develop individualized care plans that promote positive clinical outcomes and recovery.
• Applies in-depth knowledge and clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program with assigned patients.
• Reviews and analyzes clinical documentation, treatment plans, and progress notes to ensure compliance with medical necessity criteria and quality standards, providing recommendations for care coordination and resource optimization.
• Stays updated on industry guidelines, evidence-based practices, and emerging trends in behavioral health, utilizing this knowledge to inform decision-making, enhance clinical practice, and improve the quality of provided care.
• Collaborates with stakeholders, such as providers, care managers, and community organizations, to establish effective communication channels that promote care coordination efforts and facilitate the resolution of UM inquiries and concerns.
• Provides coaching and guidance to support the professional development of the UM team, promoting adherence to clinical guidelines, accuracy in documentation, and effective utilization management practices.
• Ensures a culture of continuous improvement and best practices by participating in quality improvement initiatives, contributing to the development of UM policies and procedures, and striving for excellence in behavioral health utilization management.

WHAT YOU BRING - REQUIRED

• Active, unrestricted, independent clinical licensure in good standing, such as:

• LCSW (Licensed Clinical Social Worker)

• LMFT (Licensed Marriage and Family Therapist)

• LMSW (Licensed Masters Social Worker)

• LPC (Licensed Professional Counselor)

• RN (Registered Nurse)

• 3-5 years of behavioral health clinical experience

• Strong clinical assessment, problem-solving, and decision-making skills

• Knowledge of medical terminology and utilization management principles

• Ability to manage sensitive information with professionalism and discretion

• Strong communication and collaboration skills

• Must be willing to work in MST or PST

Preferred Qualifications

• 3-5 years of Managed Care or Utilization Management experience
• Experience reviewing behavioral health services and treatment plans
• Familiarity with care coordination and interdisciplinary collaboration
• Knowledge of digital literacy skills

Education

• Bachelor's or Master's degree in a relevant field, or equivalent professional training and qualifications
• Bachelors in Nursing, Master's in Social Work/Counseling/Psychology

Why Join Us?

• Opportunity to support behavioral health outcomes for college and university students
• Collaborative, mission-driven team environment
• Meaningful work that influences quality, access, and appropriate utilization of behavioral health services
• Professional growth within a leading healthcare organization

If you're passionate about behavioral health and want to use your clinical expertise to improve access to quality care, we'd love to hear from you. Apply today!

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,522.00 - $129,615.00

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.

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.

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: 08/08/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.