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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
40Time Type
Full timePay Range
The typical pay range for this role is:
$54,095.00 - $116,760.00This 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 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.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 04/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.