Experienced Utilization Management Clinician - Behavioral Health Specialist for Remote Full-Time Position with Competitive Salary and Benefits

Introduction to CVS Health and Our Mission At CVS Health, we are driven by a singular purpose: to bring our heart to every moment of your health. This guiding principle shapes our commitment to delivering enhanced, human-centric healthcare in a rapidly changing world. Our brand, with heart at its center, sends a personal message that how we deliver our services is just as important as what we deliver. We are seeking a dedicated and compassionate Utilization Management Clinician - Behavioral Health Specialist to join our team, where you will play a vital role in transforming our culture and accelerating our ability to innovate and deliver solutions to make healthcare more personal, convenient, and affordable. Job Overview We are offering a fully remote, full-time position for a Utilization Management Clinician - Behavioral Health Specialist. As a key member of our team, you will utilize your clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. You will apply critical thinking and knowledge of clinically appropriate treatment, evidence-based care, and clinical practice guidelines for Behavioral Health and/or medical conditions. Your expertise will be essential in assessing the appropriateness of treatment plans across levels of care, applying evidence-based standards and practice guidelines to treatment, and coordinating with providers and other parties to facilitate optimal care/treatment. Key Responsibilities Utilize clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program Apply critical thinking and knowledge of clinically appropriate treatment, evidence-based care, and clinical practice guidelines for Behavioral Health and/or medical conditions Assess the appropriateness of treatment plans across levels of care and apply evidence-based standards and practice guidelines to treatment Coordinate with providers and other parties to facilitate optimal care/treatment Provide triage and crisis report, gathering clinical information and applying the appropriate clinical judgment to render coverage determination/recommendation along the continuum of care facilities Identify members at risk for poor outcomes and facilitate referral opportunities to integrate with other products, services, and/or programs Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function Requirements and Qualifications To be successful in this role, you will need to meet the following requirements: Essential Qualifications 3 years of behavioral health clinical experience in a hospital setting Active current and unrestricted Master's Level Behavioral Health clinical license in the state of residence (LMSW, LCSW, LISW, LPC, or comparable) or Registered Nurse licensure with psychiatric specialty, certification, or experience in the state of residence Proficiency with computer skills, including navigating multiple systems and keyboarding Ability to work Monday through Friday, 12pm to 8:30pm EST Preferred Qualifications MST or PST zone hours preferred Experience working with the geriatric population Crisis intervention skills preferred Managed care experience preferred Education Master's degree required if social worker, MSW, LCSW, Behavioral/mental health services Associates degree required if Registered Nurse, BSN preferred Career Growth and Learning Benefits At CVS Health, we are committed to helping our colleagues grow and develop in their careers. As a Utilization Management Clinician - Behavioral Health Specialist, you will have access to a range of learning and development opportunities, including free development courses, education assistance, and a CVS store discount. You will also be part of a team that values innovation, collaboration, and mutual respect, and that is dedicated to making a positive impact on the lives of our patients and customers. Work Environment and Company Culture Our company culture is built on a foundation of heart, compassion, and a commitment to delivering exceptional patient care. We believe in empowering our colleagues to take ownership of their work, to innovate and experiment, and to collaborate with others to achieve common goals. As a remote worker, you will be part of a virtual team that is connected by a shared purpose and a passion for delivering high-quality healthcare services. You will have the flexibility to work from the comfort of your own home, with the support of a dedicated team and the resources you need to succeed. Compensation, Perks, and Benefits We offer a competitive salary range of $54,095.60 - $116,800.00, depending on experience, education, and other factors. In addition to your base salary, you will be eligible for a CVS Health bonus, commission, or short-term incentive program. You will also have access to a range of benefits, including medical, dental, and vision coverage, a 401(k) retirement savings plan, an Employee Stock Purchase Plan, and paid time off. We believe in taking care of our colleagues, both in and out of the workplace, and we are committed to providing a supportive and inclusive work environment that allows you to thrive. Conclusion If you are a compassionate and dedicated healthcare professional who is passionate about delivering high-quality patient care, we encourage you to apply for this exciting opportunity. As a Utilization Management Clinician - Behavioral Health Specialist at CVS Health, you will be part of a team that is shaping the future of healthcare and making a positive impact on the lives of our patients and customers. Don't miss this chance to join our team and take the first step towards a rewarding new role. Apply now and discover the difference you can make at CVS Health. Submit Your Application Seize this opportunity to make a significant impact. Apply now and take the first step towards a rewarding new role. Apply for this job