Manager, Behavioral Health Utilization Management - IL Medicaid
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 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.
Requirements
- 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.
Nice To Haves
- Illinois residency.
- Managed care experience.
- Medicaid experience.
- Strong ability to multitask, prioritize, and adapt to a fast-paced, changing environment.
Responsibilities
- 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.
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Manager
