Utilization Management Clinician - Behavioral Health

CVS Health

5d • Remote

About The Position

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary Fully remote in the USA. Utilizes clinical experience, and skills, in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guidelines to treatment where appropriate. • Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Provides triage and crisis support. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning. Coordinates with providers and other parties to facilitate optimal care/treatment. Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management functions. Must be able to talk on the telephone and type at the same time, this has some queue based work involved Candidate must be available to work within the hours of Monday- Friday 10am-8:30pm EST. No holidays and no weekends.

Requirements

• 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.
• Unencumbered Independent Behavioral Health clinical license in the state where they work. Must have one of the following or equivalent: (LPC, LPCC, LMHCS, LMHC, LMFT, LCSW) OR RN with 3+ years of clinical behavioral health experience required.
• Must be able to talk on the telephone and type at the same time, this has some queue based work involved
• Candidate must be available to work within the hours of Monday- Friday 10am-8:30pm EST. No holidays and no weekends.
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
• Sedentary work involving periods of sitting, talking, listening.
• Work requires sitting for extended periods, talking on the telephone and typing into the computer
• Masters Degree in behavioral health profession OR RN with BSN

Nice To Haves

• Knowledge of mental health and substance abuse disorders
• Managed care/utilization review experience
• Crisis intervention skills

Responsibilities

• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Provides triage and crisis support.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning.
• Coordinates with providers and other parties to facilitate optimal care/treatment.
• Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management functions.

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
• Number of Employees: 5,001-10,000 employees