Behavioral Health Clinical Utilization Specialist
3 days ago
At CVS Health, we're committed to delivering innovative solutions that make healthcare more personal, convenient and affordable.
Position Overview
We're seeking a skilled Behavioral Health Clinical Utilization Specialist to join our team. As a key member of our clinical team, you'll play a critical role in assessing the appropriateness of treatment plans and ensuring that our members receive the best possible care.
About the Role
This is a remote opportunity working 12pm-8:30pm eastern time. You'll be responsible for coordinating and monitoring healthcare services/benefits for members, providing triage and crisis support, and gathering clinical information to render coverage determination/recommendations.
Key Responsibilities
- Utilize clinical experience and skills to assess the appropriateness of treatment plans and apply evidence-based standards and practice guidelines.
- Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
- Provide triage and crisis support to members.
- Gather clinical information and apply clinical criteria/guidelines to render coverage determination/recommendation.
- Identify members at risk for poor outcomes and facilitate referral opportunities to integrate with other products, services and/or 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 in a hospital setting or alternative care setting.
- Unencumbered Behavioral Health clinical license in the state where you work.
- One of the following licenses: LPC, LMSW, LSW, LISW, LMFT, LMHC, LCSW, or RN with behavioral health experience.
- Ability to talk on the telephone and type simultaneously.
Preferred Qualifications
- Knowledge of mental health and substance abuse disorders.
- Managed care/utilization review experience.
- Crisis intervention skills.
Education
- Masters Degree in behavioral health profession.
- RN degree with 3 years of behavioral health experience.
Compensation
The estimated annual salary for this role is $54,095.60 - $116,800.00, based on location and experience. In addition to your compensation, enjoy the rewards of an organization that puts its heart into caring for its colleagues and communities. Benefits include medical, dental, and vision coverage, a 401(k) retirement savings plan, employee stock purchase plan, term life insurance, short-term and long-term disability benefits, paid time off, and more.
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