Utilization management Clinician Behavioral Health

" 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 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. 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. Required Qualifications • 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 ?Preferred Qualifications • 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. Education • Master's degree required if social worker, LPC, LCSW, LMFT, LMHC, Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 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 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: 04/30/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. ", Apply Job!