Clinical Utilization Specialist Behavioral Health

3 weeks ago


Sandy, United States CVS Health Full time
Job Summary

CVS Health is seeking a highly skilled Clinical Utilization Specialist to join our team. As a key member of our Behavioral Health team, you will play a critical role in coordinating, documenting, and communicating all aspects of our utilization/benefit management program.

Key Responsibilities:

  • Utilize clinical skills to coordinate and document all aspects of the utilization/benefit management program.
  • Apply critical thinking and knowledge of clinically appropriate treatment, evidence-based care, and clinical practice guidelines for Behavioral Health and/or medical conditions.
  • Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.
  • Provide triage and crisis report, gathering clinical information and applying appropriate clinical judgment to render coverage determination/recommendation.
  • Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Requirements:

  • 3+ years of behavioral health clinical experience in a hospital setting.
  • Active current and unrestricted Master's Level Behavioral Health clinical license in the state of residence (LMSW, LCSW, LISW, LPC, or comparable) or Registered Nurse licensure with psychiatric specialty, certification, or experience in state of residence.
  • Ability to work Monday through Friday 12pm to 8:30pm EST.

Preferred Qualifications:

  • MST or PST zone hours preferred.
  • Experience working with geriatric population.
  • Crisis intervention skills preferred.
  • Managed care preferred.

Education:

  • Master's degree required if social worker, MSW, LCSW, Behavioral /mental health services OR
  • If Registered Nurse, Associates degree required, BSN preferred.

Pay Range:

The typical pay range for this role is: $60,522.80 - $129,615.20

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.

Benefits:

CVS Health offers a comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, and employee stock purchase plan. We also offer a fully-paid term life insurance plan, short-term and long-term disability benefits, and numerous well-being programs.

Equal Opportunity Employer:

CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action 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 federal, state, or local law.



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