Utilization Management Clinician- Behavioral Health

CVS Health

4d • 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 As a Utilization Management Clinician - Behavioral Health you will 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 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.

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.
• 1+ years of MS Office experience to include navigating multiple systems and keyboarding
• Must have active current and unrestricted Behavioral Health clinical licensure (LPC, LSW, LISW, LMFT, LMHC, LCSW) in state of residence or RN in state of residence with behavioral health experience required.
• Must be willing and able to work Monday through Friday with flexible hours between 10:00am to 8:00pm EST.
• Must be able to talk on the telephone and type at the same time, this has some queue based work involved
• 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

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

Responsibilities

• 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
• Provide triage and crisis support
• Gather 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
• 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
• 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 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