Job Description
Role Description
- We are seeking a compassionate, clinically skilled professional to join our Utilization Management team. In this role, you will use your behavioral health or nursing expertise to support members in receiving high‑quality, evidence‑based care. You’ll play a vital part in evaluating treatment plans, coordinating services, and ensuring members receive the right care at the right time. This position is ideal for someone who enjoys clinical assessment, problem‑solving, and collaboration in a fast‑paced environment.
- Apply clinical expertise to review and evaluate treatment plans across various levels of care, ensuring alignment with evidence‑based standards and clinical guidelines.
- Coordinate, monitor, and assess healthcare service options to ensure members receive appropriate and cost‑effective care.
- Provide clinical triage and crisis support as needed.
- Collect and assess clinical information to determine coverage recommendations, including discharge planning and transitions of care.
- Collaborate with providers and interdisciplinary teams to facilitate optimal treatment outcomes.
- Identify high‑risk members and connect them with appropriate internal programs, services, or additional supports.
- Recognize opportunities to enhance the quality and effectiveness of healthcare services while optimizing benefit use.
- Serve as a clinical resource to internal teams and external partners regarding utilization management processes.
- Perform responsibilities while working primarily at a computer with extended periods of phone communication.
- Qualifications
- Master’s‑level Behavioral Health clinical license, unencumbered and active in the state of residence (e.g., LMSW, LCSW, LISW, LPC, LMFT), OR Registered Nurse (RN) with an active license in the state of residence
- 3+ years of behavioral health clinical experience in a hospital setting (required for both BH clinicians and RNs)
- 1+ year of utilization review or utilization management experience (e.g., concurrent review, pre‑certifications)
- Preferred Qualifications
- Experience working with geriatric or chronically mentally ill populations
- Experience supporting high‑risk member populations
- Strong computer proficiency, including navigating multiple systems and accurate keyboarding
- Education
- Master’s degree in Social Work (MSW), LCSW, or related behavioral/mental health field OR Registered Nurse with behavioral health experience or background
- Anticipated Weekly Hours
- 40
- Time Type
- Full time
Pay Range
The typical pay range for this role is: $60,522.00 - $129,615.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
- Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
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