Utilization Management Clinician, Behavioral Health

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🔥 0 minutes ago

🥔 Idaho, Utah, +1 more states – Remote

🥔 Idaho – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote

💵 $54.1k - $142.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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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 • Escalate 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

🎯 Requirements

• Active, unrestricted independent behavioral health clinical license in the state of residence, including 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 • Must be available for the stated Thursday-Friday and Saturday-Sunday night-shift schedule • Must be available to work holidays • Hospital-based behavioral health experience preferred • Utilization Management or Prior Authorization experience preferred • Managed Care experience preferred • 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

🏖️ Benefits

• 10% shift differential • Fully remote position available anywhere in the U.S. • Opportunity to apply clinical expertise in a non-traditional setting • Meaningful work that improves access to quality behavioral health care • Collaborative, mission-driven team environment • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being of colleagues and their families • CVS Health bonus, commission or short-term incentive program in addition to base pay range