Utilization Management Clinician Behavioral Health

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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

Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.

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 Qualifications

• 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, LMSW, 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. Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours

Preferred Qualifications

• Knowledge of mental health and substance abuse disorders

• Managed care experience

• Utilization review experience

• Crisis intervention skills

Education

Masters Degree in behavioral health profession or if RN Associates degree required, BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $116,760.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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 scre