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Clinical Utilization Management Specialist
2 months ago
CVS Health is seeking a skilled Clinical Utilization Management 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 effective and efficient 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 applicable.
- 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, policies, and procedures to render coverage determinations and recommendations.
- Coordinate with healthcare 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 and services.
- Consult and lend expertise to internal and external constituents in the coordination and administration of utilization and benefit management functions.
- 3+ years of direct clinical practice experience post-masters degree, preferably in a hospital setting or alternative care setting.
- Unencumbered independent behavioral health clinical license in the state where you work.
- Proficiency with computer skills, including navigating multiple systems and keyboarding.
- Knowledge of mental health and substance abuse disorders.
- Managed care and utilization review experience.
- Crisis intervention skills.
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 paid time off, paid holidays, and a fully-paid term life insurance plan.
