Utilization Management Clinician Behavioral Health - Autism Care Team - Work at Home

CVS Health

3d • Remote

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 - Working schedule is Monday-Friday standard business hours. No nights, weekends or holidays. EST or CST residents preferred due to region of members. As a UM Clinician Behavioral Health you will: Utilize clinical experience and skills in a collaborative process to assess appropriateness of treatment plans for Applied Behavior Analysis (ABA) services and applies evidence based standards and practice guidelines to treatment where appropriate. Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members. Provide triage and crisis support. Gather clinical information and applies the appropriate clinical criteria/guidelines, policy, procedure, and clinical judgment to render coverage. Gives providers determinations/recommendations along the continuum of care facilitates including effective discharge planning. Coordinate with providers and other parties to facilitate optimal care/treatment. Identify members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services, and/or programs. Outreach members to provide resources and education, answer questions, and offer referrals for additional services covered by the member's plan. Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization. Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Requirements

• 3+ years of direct clinical practice experience post master’s degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
• 2+ years of crisis intervention experience
• 3+ years of experience working with clients with an Autism Diagnosis
• Valid unrestricted independent professional behavioral health clinical license to practice per state regulations in the state they reside in/ one or more or equivalent is required: LBS, LBA, LPC, LMFT, LCSW, LCPC, LMHC, LCMHC, LICSW, LISW, Clinical Psychologist.
• Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps in order to ensure sufficient speed to adequately perform work duties.

Nice To Haves

• Previous Managed Care experience

Responsibilities

• Utilize clinical experience and skills in a collaborative process to assess appropriateness of treatment plans for Applied Behavior Analysis (ABA) services and applies evidence based standards and practice guidelines to treatment where appropriate.
• Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Provide triage and crisis support.
• Gather clinical information and applies the appropriate clinical criteria/guidelines, policy, procedure, and clinical judgment to render coverage.
• Gives providers determinations/recommendations along the continuum of care facilitates including effective discharge planning.
• Coordinate with providers and other parties to facilitate optimal care/treatment.
• Identify members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services, and/or programs.
• Outreach members to provide resources and education, answer questions, and offer referrals for additional services covered by the member's plan.
• Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

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