Manager, Behavioral Health Utilization Management - IL Medicaid

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.

Fundamental Components

• 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.

Minimum Qualifications

• 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.

Preferred Qualifications

• Illinois residency.

• Managed care experience.

• Medicaid experience.

• Strong ability to multitask, prioritize, and adapt to a fast-paced, changing environment.

Education & Licensure

• If Registered Nurse:

  • Master’s degree or equivalent experience required (BSN preferred).

  • Active, unrestricted Illinois RN license.

• If Behavioral Health:

  • Master’s degree in a field leading to independent Behavioral Health licensure.

  • Current, unencumbered Illinois license as one of the following:

    • Licensed Clinical Professional Counselor (LCPC)

    • Licensed Clinical Social Worker (LCSW)

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$95,738.00 - $206,206.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within