Behavioral Health Utilization Management Clinician - Registered Nurse or Behavioral Health Clinician

CVS Health

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About The Position

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 Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. Concurrent Medical Reviews for Commercial Plans. Collaborating with facilities and providers to document and review for extended stay request.

Requirements

• Licensed Registered Nurse (Compact RN a Plus) with 3 or more years of Behavioral Health Clinical Experience.
• Independently licensed behavioral health clinician in state of residence.
• 3+ years post degree experience in a psychiatric or substance abuse setting required
• 3 years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.
• Master's degree in Behavioral/Mental health or Human Service/Health Services
• Associates degree with a Registered Nurse

Nice To Haves

• 3 years Managed care/utilization review experience preferred.
• Crisis intervention skills and experience preferred
• Proficiency with computer and technology skills which includes navigating multiple systems and keyboarding.
• California license or ability to obtain California license preferred

Responsibilities

• Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
• Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.
• Concurrent Medical Reviews for Commercial Plans.
• Collaborating with facilities and providers to document and review for extended stay request.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level