Behavioral Health Utilization Specialist

1 week ago

Harrisburg, Pennsylvania, United States CVS Health Full time

About CVS Health

At CVS Health, we are dedicated to enhancing health care through a human-centric approach. Our mission is to ensure that every moment of your health is approached with compassion and understanding. We believe that how we deliver our services is just as crucial as the services themselves, and we are committed to fostering a culture of innovation and care.

Position Overview

This role is a full-time, remote position with a standard working schedule from Monday to Friday, ensuring a work-life balance without the need for nights, weekends, or holidays.

Key Responsibilities

  • Leverage clinical expertise to collaboratively evaluate the suitability of treatment plans for Applied Behavior Analysis (ABA) services, utilizing evidence-based standards and guidelines.
  • Coordinate, monitor, and assess healthcare options to ensure members receive appropriate services and benefits.
  • Provide crisis intervention and triage support as needed.
  • Collect clinical data and apply relevant clinical criteria, policies, and procedures to make informed coverage decisions.
  • Offer recommendations and determinations to providers throughout the care continuum, facilitating effective discharge planning.
  • Work closely with providers and other stakeholders to optimize care and treatment outcomes.
  • Identify members at risk for adverse outcomes and facilitate referrals to integrate with additional services and programs.
  • Engage with members to provide resources, education, and answers to inquiries regarding their coverage.
  • Identify opportunities to enhance the quality and effectiveness of healthcare services and benefit utilization.
  • Consult with internal and external partners regarding the coordination and administration of utilization and benefit management functions.

Required Qualifications

  • A minimum of 3 years of direct clinical practice experience following a master's degree, preferably in a hospital or outpatient setting.
  • At least 2 years of experience in crisis intervention.
  • A minimum of 3 years of experience working with clients diagnosed with Autism.
  • A valid, unrestricted independent professional behavioral health clinical license in accordance with state regulations, such as LBS, LBA, LPC, LMFT, LCSW, LCPC, LMHC, LCMHC, LICSW, LISW, or Clinical Psychologist.
  • Access to a residential broadband service with internet speeds of at least 25 mbps/3mbps to perform job duties effectively.

Preferred Qualifications

  • Experience in Managed Care settings.

Education

A Master's degree in Behavioral/Mental Health or Human Services/Health Services is required.

Compensation and Benefits

The anticipated pay range for this position is between $60,000 and $129,615.20 annually. This range reflects the base salary for all roles within this job grade, with actual offers varying based on experience, education, and geographical location. In addition to competitive pay, CVS Health offers a comprehensive benefits package, including medical, dental, and vision coverage, a 401(k) retirement savings plan, and an Employee Stock Purchase Plan. Eligible employees also receive fully-paid term life insurance, short-term and long-term disability benefits, and access to numerous well-being programs. Paid Time Off (PTO) and paid holidays are also provided in accordance with company policies.

Diversity and Inclusion

CVS Health is an equal opportunity and affirmative action employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

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