Utilization Management Clinician - Behavioral Health

Fully remote in the USA. 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.

• 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
• Coordinates, 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

• 3+ years of direct clinical practice experience post-master's degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
• Unencumbered Independent Behavioral Health clinical license in the state where they work
• Must have one of the following or equivalent: (LPC, LPCC, LMHCS, LMHC, LMFT, LCSW) OR RN with 3+ years of clinical behavioral health experience required

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
• 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

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.