Autism Care Utilization Management Specialist

2 weeks ago

Harrisburg, Pennsylvania, United States CVS Health Full time

About CVS Health

At CVS Health, we are united by a common mission: to bring compassion to every aspect of health care. Our commitment is to provide innovative, human-centered health solutions that adapt to the evolving needs of our communities.

Position Overview

This role is a full-time, remote position, operating during standard business hours from Monday to Friday, with no requirements for nights, weekends, or holidays.

Key Responsibilities

  • Leverage clinical expertise to collaboratively evaluate the suitability of treatment plans for Applied Behavior Analysis (ABA) services, applying evidence-based standards and guidelines as necessary.
  • Coordinate, monitor, and assess options to ensure members receive appropriate healthcare services and benefits.
  • Provide crisis intervention and triage support as needed.
  • Collect clinical data and apply relevant clinical criteria, policies, and procedures to make informed coverage decisions.
  • Offer recommendations and determinations to providers throughout the care continuum, including effective discharge planning.
  • Collaborate with healthcare providers and other stakeholders to ensure optimal treatment and care.
  • Identify members at risk for adverse outcomes and facilitate referrals to integrate additional services and programs.
  • Engage with members to provide resources, education, and answers to inquiries regarding their health plans.
  • Identify opportunities to enhance the quality and effectiveness of healthcare services and benefit utilization.
  • Consult with internal and external stakeholders to support the administration of utilization and benefit management functions.

Required Qualifications

  • A minimum of 3 years of direct clinical experience following a master's degree, preferably in a hospital or outpatient setting.
  • At least 2 years of experience in crisis intervention.
  • A minimum of 3 years of experience working with clients diagnosed with Autism.
  • A valid, unrestricted independent professional behavioral health clinical license in accordance with state regulations, such as LBS, LBA, LPC, LMFT, LCSW, LCPC, LMHC, LCMHC, LICSW, LISW, or Clinical Psychologist.
  • Access to a residential broadband service with a minimum speed of 25 mbps/3mbps to effectively perform job duties.

Preferred Qualifications

  • Experience in Managed Care settings.

Education

A master's degree in Behavioral/Mental Health or Human Services/Health Services is required.

Compensation and Benefits

The typical pay range for this position is $60,000 to $129,615.20 annually. This range reflects the base salary for all roles within the job grade. Actual salary offers will be influenced by various factors including experience, education, and geographic location. This position is also eligible for bonuses, commissions, or short-term incentive programs in addition to the base salary.

CVS Health offers a comprehensive benefits package, including medical, dental, and vision coverage, a 401(k) retirement savings plan, and an Employee Stock Purchase Plan. Eligible employees receive fully-paid term life insurance, short-term and long-term disability benefits, and access to numerous well-being programs and educational assistance. Paid Time Off (PTO) and paid holidays are also provided in accordance with company policies.

Diversity and Inclusion

CVS Health is an equal opportunity and affirmative action employer. We are committed to creating a diverse environment and do not discriminate based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable law.

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