CVS Health Utilization Management Clinician - Behavioral Health in Sandy, Utah
Remote roleSchedule is Monday-Friday. This position will cover the late shift of 12/Noon to 8:30pm EST.• 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 guidelines to treatment where appropriate. • Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. • Provides triage and crisis support. • Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates 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
Candidate must be licensed in the state in which they will be working • Requires knowledge of mental health and substance abuse disorders • Must be able to talk on the telephone and type at the same time, this is a queue based. We are looking for a candidate who has past insurance/managed care experience, has case management skills, and has experience working on crisis calls. We need a person who works well in a team environment as well as able to work independently.Requires full licensure, active, and unrestricted in one of the following: LCSW, LISW, with behavioral health specialty, LPC, LMHC, LMFT, or other behavioral health licensure
Master degree or higher
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.