Utilization Management Clinician Behavioral Health

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Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary
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) or active and good standing RN license.
– 3+ years of behavioral health experience

– Knowledge of mental health and substance abuse disorders.
– 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, Behavioral /mental health services or if Registered Nurse, Associates degree required, BSN preferred

Pay Range

The typical pay range for this role is:

$54,095.60 – $116,800.00

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 04/16/2024