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Clinical Utilization Specialist

2 months ago

Salt Lake, Utah, United States CVS Health Full time
Position Overview

At CVS Health, we are dedicated to enhancing the health and well-being of our communities. Our mission is to provide personalized healthcare solutions that are both accessible and affordable.

Role Summary
This position is fully remote within the United States, operating Monday through Friday from 12 PM to 8:30 PM EST, with no weekends or holidays required.

Key Responsibilities
  • Utilize clinical expertise in a collaborative manner to evaluate the suitability of treatment plans across various care levels, applying evidence-based standards and clinical guidelines as necessary.
  • Coordinate, monitor, and assess options to ensure members receive appropriate healthcare services and benefits.
  • Provide triage and crisis intervention support.
  • Collect clinical data and apply relevant clinical criteria, policies, and procedures to make informed coverage determinations throughout the care continuum, including effective discharge planning.
  • Collaborate with healthcare providers and other stakeholders to ensure optimal treatment and care.
  • Identify members at risk for adverse outcomes and facilitate referrals to integrate additional services and programs.
  • Recognize opportunities to enhance the quality and effectiveness of healthcare services and benefit utilization.
  • Consult with internal and external stakeholders regarding the coordination and administration of utilization and benefit management functions. Proficiency in multitasking, including phone communication while documenting information, is essential.

Required Qualifications
  • A minimum of 3 years of direct clinical practice experience following a master's degree, preferably in a hospital or outpatient care setting.
  • An unencumbered Independent Behavioral Health clinical license in the state of employment.

Preferred Qualifications
  • Familiarity with mental health and substance use disorders.
  • Experience in managed care or utilization review.
  • Skills in crisis intervention.
  • Proficiency in computer systems, including the ability to navigate multiple platforms and perform data entry simultaneously.
  • Ability to engage in sedentary work, which includes extended periods of sitting, talking, and listening.

Education
A Master's Degree in a behavioral health field is required. Registered Nurses must possess a Bachelor's Degree.

Compensation and Benefits
The typical pay range for this role is between $54,000 and $116,760.80 annually. This range reflects the base hourly rate or annual salary for all positions within this job grade. Actual salary offers will vary based on factors such as experience, education, and geographic location. This position is eligible for bonuses, commissions, or short-term incentive programs in addition to the base salary.

CVS Health offers a comprehensive benefits package, including medical, dental, and vision coverage, a 401(k) retirement savings plan, an Employee Stock Purchase Plan, fully-paid life insurance, and both short-term and long-term disability benefits. Employees also have access to various well-being programs, educational assistance, free development courses, and discounts at CVS stores and with participating partners. Paid Time Off (PTO) and paid holidays are provided in accordance with state laws and company policies.

Diversity and Inclusion
CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruitment, 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 law.