Clinical Utilization Specialist

23 hours 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 Clinical Utilization Specialist, you will play a critical role in assessing the appropriateness of treatment plans and applying evidence-based standards and practice guidelines to ensure optimal patient care.

Key Responsibilities
  • Utilize clinical experience and skills to assess treatment plans and apply evidence-based standards and practice guidelines.
  • Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.
  • Provide triage and crisis support to members.
  • Gather clinical information and apply clinical criteria, guidelines, policy, procedure, and judgment to render coverage determination 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.
  • Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.
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 required.
Preferred Qualifications
  • Knowledge of mental health and substance abuse disorders.
  • Managed care/utilization review experience.
  • Crisis intervention skills.
  • Position requires 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.
Pay Range

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.



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