CVS Health
Remote/Telecommute
Utilization Management Clinician - Behavioral Health
Posted over 1 month ago
Job Description
Job Description
Work at home role but applicants must reside in Arizona.
Potential for occasional travel around Maricopa County.
Standard business hours required Monday - Friday.
-Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
-Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services.
-Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
-Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
-Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)
-Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
-Identifies members who may benefit from care management programs and facilitates referral
-Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
Required Qualifications
-3+ years clinical practice experience, e.g., hospital setting, residential facility, outpatient clinic, alternative care setting such as home health or ambulatory care required.
-Accepted independent licenses: Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marital and Family Therapist (LMFT), or active unrestricted Arizona state RN license with behavioral health experience.
-Must reside in Arizona
-Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
Preferred Qualifications
-Managed care/utilization review, concurrent review, and/or prior authorization experience preferred.
Education
Master's degree required with independent licensure (LCSW, LPC, and LMFT)
Associate's Degree required with RN licensure
Business Overview
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.
Work at home role but applicants must reside in Arizona.
Potential for occasional travel around Maricopa County.
Standard business hours required Monday - Friday.
-Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
-Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services.
-Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
-Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
-Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)
-Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
-Identifies members who may benefit from care management programs and facilitates referral
-Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
Required Qualifications
-3+ years clinical practice experience, e.g., hospital setting, residential facility, outpatient clinic, alternative care setting such as home health or ambulatory care required.
-Accepted independent licenses: Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marital and Family Therapist (LMFT), or active unrestricted Arizona state RN license with behavioral health experience.
-Must reside in Arizona
-Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
Preferred Qualifications
-Managed care/utilization review, concurrent review, and/or prior authorization experience preferred.
Education
Master's degree required with independent licensure (LCSW, LPC, and LMFT)
Associate's Degree required with RN licensure
Business Overview
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.
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