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Clinical Utilization Specialist

2 months ago

Jackson, Mississippi, United States CVS Health Full time
Job Summary

CVS Health is seeking a skilled Clinical Utilization Specialist to join our team. As a key member of our healthcare team, you will play a critical role in ensuring that our members receive the most appropriate and effective care possible.

Key Responsibilities
  • Utilize clinical expertise to assess the appropriateness of treatment plans and apply evidence-based standards and practice guidelines to treatment where necessary.
  • Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.
  • Provide triage and crisis support to members in need.
  • Gather clinical information and apply clinical criteria, guidelines, policy, procedure, and judgment to render coverage determinations and recommendations.
  • Coordinate with providers and other parties to facilitate optimal care and treatment.
  • Identify members at risk for poor outcomes and facilitate referral opportunities to integrate with other products, services, and programs.
  • Consult and lend expertise to internal and external constituents in the coordination and administration of the utilization/benefit management function.
Requirements
  • 3 years of direct clinical practice experience post-masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.
  • Unencumbered Behavioral Health clinical license in the state where they work.
  • Must have one of the following: LPC, LMSW, LSW, LISW, LMFT, LMHC, LCSW, or RN with behavioral health experience.
Preferred Qualifications
  • Knowledge of mental health and substance abuse disorders.
  • Managed care/utilization review experience.
  • Crisis intervention skills.
  • Proficiency with computer skills, including navigating multiple systems and keyboarding.
Education
  • Masters Degree in behavioral health profession.
  • RN degree with 3 years of behavioral health experience.
Compensation

The typical pay range for this role is $54,116.80. 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.

CVS Health offers a comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, and employee stock purchase plan. Eligible employees may also participate in the Company's term life insurance plan, short-term and long-term disability benefits, and well-being programs. CVS Health is an equal opportunity employer and welcomes applications from diverse candidates.