Utilization Management Clinician, Behavioral Health

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🔥 12 minutes ago

🏈 Alabama, Alaska, +41 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🦬 Wyoming – Remote

💵 $54.1k - $142.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Review preauthorization requests for behavioral health services using evidence-based guidelines and clinical judgment • Coordinate, document, and communicate utilization management decisions with providers and stakeholders • Manage crisis calls, assess risk, determine support needs, and coordinate appropriate interventions, including escalation for suicide risk, self-harm concerns, and welfare checks when necessary • Apply clinical expertise to support quality, cost-effective care and positive member outcomes • Work in a fast-paced, queue-based environment while managing multiple priorities • Collaborate with providers and care teams to facilitate appropriate levels of care • Work the specified night-shift schedule: Saturday and Sunday 12pm–10pm MT; Thursday and Friday 3pm–1am MT

🎯 Requirements

• Active, unrestricted independent behavioral health clinical license in the state of residence: LCSW, LICSW, LISW, LMSW, LPC, LMHC, LCMHC, LMFT, Clinical Psychologist, or RN • 3+ years of post-licensure behavioral health experience • 3+ years of experience working with mental health and substance use disorders • Ability to effectively manage telephonic and computer-based work simultaneously • High-speed residential internet service with minimum 25 Mbps download and 3 Mbps upload • Availability to work holidays • Behavioral Health Clinicians: Master's degree in Social Work, Counseling, or Psychology • Registered Nurses: Bachelor's degree in Nursing with an emphasis in Behavioral Health or Psychology • Hospital-based behavioral health experience preferred • Utilization Management or Prior Authorization experience preferred • Managed Care experience preferred

🏖️ Benefits

• 12.5% shift differential • CVS Health bonus, commission or short-term incentive program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being

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