Manager, Behavioral Health Utilization Management - IL Medicaid

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. Position Summary This is a fulltime remote teleworker opportunity in Illinois. The Manager, Utilization Management, conducts oversight and management of clinical team processes including the organization and development of high performing teams. This is a fully remote position. Eligible candidates may live anywhere in the contiguous US; however, Illinois residence is preferred. Fundamental Components Reinforces clinical philosophy, programs, policies and procedures. Communicates strategic plan and specific tactics to meet plan. Ensures implementation of tactics to meet strategic direction for cost and quality outcomes. Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results. Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes. Will be accountable for meeting the financial, operational and quality objectives of the department. Will be accountable for the day-to-day management of team(s) for appropriate implementation and adherence with established practices, policies and procedures. Works closely with other functional area managers to ensure consistency in clinical interventions supporting our plan sponsors. Develop, initiate, monitor and communicate performance expectations. May act as a single point of contact for the customer and the Account Team which includes participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers. Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills. Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams. Consistently demonstrates the ability to serve as a model change agent and lead change efforts. Accountable for maintaining compliance with policies and procedures and implements them at the employee level. Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.

Minimum Qualifications

Active, unrestricted clinical licensure (RN or Behavioral Health as outlined below). 5+ years of clinical practice in behavioral healthcare. 2+ years of utilization management experience (managed care setting preferred). 2+ years of healthcare leadership experience (managed care setting preferred). 2+ years of proficiency with personal computers, keyboard navigation, and MS Office Suite. 1+ year of experience with electronic medical records. Ability to travel up to 10% for in-state meetings. Ability to work core business hours (Mon–Fri, 8 AM–5 PM CT) with occasional weekend flexibility. High-speed internet access.

Preferred Qualifications

Illinois residency. Managed care experience. Medicaid experience. Strong ability to multitask, prioritize, and adapt to a fast-paced, changing environment. Education & Licensure If Registered Nurse: Master’s degree or equivalent experience required (BSN preferred). Active, unrestricted Illinois RN license. If Behavioral Health: Master’s degree in a field leading to independent Behavioral Health licensure. Current, unencumbered Illinois license as one of the following: Licensed Clinical Professional Counselor (LCPC) Licensed Clinical Social Worker (LCSW) Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $95,738.00 - $206,206.00 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: 06/13/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply To This Job