Utilization Management Clinician Behavioral Health

- Utilize clinical experience and skills in a collaborative process to assess appropriateness of treatment plans for ABA services and applies evidence based standards and practice guidelines to treatment where appropriate.

- Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.

- Provide triage and crisis support.

- Gather clinical information and applies the appropriate clinical criteria/guidelines, policy, procedure, and clinical judgment to render coverage. Gives providers determinations/recommendations along the continuum of care facilitates including effective discharge planning.

- Coordinate with providers and other parties to facilitate optimal care/treatment.

- Identify members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services, and/or programs.

- Outreach members to provide resources and education, answer questions, and offer referrals for additional services covered by the member's plan.

- Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.

- Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.Required Qualifications

- Valid unrestricted independent professional behavioral health clinical license to practice per state regulations in the state they reside in/ one or more or equivalent is required: LPC, LMFT, LCSW, LCPC, LMHC, LCMHC, LICSW, LISW, LBS, LBA, Clinical Psychologist.- 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- 2 years of crisis intervention experience-3 years of experience working with clients with an autism diagnosis- Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps in order to ensure sufficient speed to adequately perform work duties. Some candidates may be eligible for partial reimbursement of the cost of residential broadband service.Preferred Qualifications

-Previous Managed Care experienceEducation

-Master's degree in Behavioral/Mental health or Human Service/Health Services Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$54,095.00 - $116,760.00This 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 peopleWe 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/benefitsWe anticipate the application window for this opening will close on: 05/05/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.