Utilization Management Clinician - Behavioral Health
CVS Pharmacy - Pittsburgh, PA
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Job DescriptionFully remoteStandard business hoursNo nights, and no weekends.Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care an clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.- Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guideline to treatment where appropriate. - Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. - Provides triage and crisis report. - Gathers clinical information and applies the appropriate clinical judgment to render coverage determination/recommendation along the continuum of care facilities including effective discharge planning. - Coordinates with providers and other parties to facilitate optimal care/treatment. - Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs. - Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization. - Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.- Work requires sitting for extended periods, talking on the telephone and typing on the computer.Pay RangeThe typical pay range for this role is:Minimum: 58,760Maximum: 125,840Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications- One of the following is required: Unencumbered Master's Level Behavioral Health clinical license in the state where they work (LMSW, LCSW, LISW, LPC, LMFT etc) or Registered Nurse in state of residence -3+ years of behavioral health clinical experience in a hospital setting required-1+ years of utilization review/utilization management required (ie. concurrent review, pre-certifications)Preferred Qualifications- Experience working with geriatric population- Crisis intervention skills preferred. - Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. - Managed care preferred (MCO)EducationMaster's degree social worker, MSW, LCSW, Behavioral /mental health services or Registered Nurse with Behavioral Health experience/backgroundBusiness OverviewBring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, 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 federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
Created: 2024-09-07