Utilization Management Clinician, Autism Care Team-Behavioral Health

Bring 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.Position Summary:This is a full-time, remote role. Looking for someone located in any state within the Central(CST), or Mountain (MST) zones.Working schedule is Monday-Friday standard business hours. No nights, weekends or holidays.As a UM Clinician Behavioral Health you will:

Utilize clinical experience and skills in a collaborative process to assess appropriateness of treatment plans for Applied Behavior Analysis (ABA) services and applies evidence based standards and practice guidelines to treatment where appropriate.

Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.

Provide triage and crisis support.

Gather clinical information and applies the appropriate clinical criteria/guidelines, policy, procedure, and clinical judgment to render coverage.

Gives providers determinations/recommendations along the continuum of care facilitates including effective discharge planning.

Coordinate with providers and other parties to facilitate optimal care/treatment.

Identify members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services, and/or programs.

Outreach members to provide resources and education, answer questions, and offer referrals for additional services covered by the member's plan.

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.

Required Qualifications

3 years of direct clinical practice experience post master’s degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility

2 years of crisis intervention experience

3 years of experience working with clients with an Autism Diagnosis

Valid unrestricted independent professional behavioral health clinical license to practice per state regulations in the state they reside in/ one or more or equivalent is required: LBS, LBA, LPC, LMFT, LCSW, LCPC, LMHC, LCMHC, LICSW, LISW, Clinical Psychologist.

Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps in order to ensure sufficient speed to adequately perform work duties. Some candidates may be eligible for partial reimbursement of the cost of residential broadband service.

Preferred Qualifications

Previous Managed Care experience

EducationMaster's degree in Behavioral/Mental health or Human Service/Health ServicesPay RangeThe typical pay range for this role is:$60,522.80 - $129,615.20This 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.In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)We anticipate the application window for this opening will close on: 10/03/2024Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.We are an equal opportunity and affirmative action employer. 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.