Utilization Management Clinician Behavioral Health, CVS Health

CVS Health

Location:
United States

Category:
Nursing

Contract Type:
Employment contract

Salary:

60522.00 - 129615.00 USD / Year

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Job Description:

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. Fully remote position. Work from home anywhere in the U.S.A. Shift: Monday through Friday 11:30am to 8pm EST. Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health, among other responsibilities.

Job Responsibility:

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program
Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health
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
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

Requirements:

Must have active current and unrestricted Independent clinical behavioral health license in the state of residence (LPC, LCSW, LMFT, LMHC, etc)
3+ years of behavioral health experience
Must be able to talk on the telephone and type at the same time as this is a queue based position
Must be able to work Monday through Friday 11:30am to 8pm EST

Nice to have:

3+ years of direct clinical practice experience post master's degree, including hospital setting or alternative care setting such as ambulatory care or outpatient program
Managed care and utilization review experience preferred
Crisis intervention skills preferred

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for wellness, tobacco cessation, and weight management
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
March 19, 2025

Expiration:
April 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Utilization Management Clinician Behavioral Health