Remote Manager, Utilization Management Clinical Services – Behavioral Health

CVS Health

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Job ID: 2567970BR
Category: Nurse
Remote: Fully Remote

Job Description
Business Overview
Aetna Better Health of Oklahoma, a CVS Health company, embodies the vision to be a trusted health partner in the local Oklahoma communities we serve. We provide a full array of innovative services that enhance overall wellness and improve everyday life for our members. At Aetna Better Health of Oklahoma, we value professional development and career growth. You will work along other colleagues who align on Heart at Work behaviors and bringing your heart to every moment of health. We will support you all the way!

This is a fulltime teleworker opportunity in Oklahoma. The Manager, UM Clinical Services, conducts oversight and management of clinical team processes including the organization and development of high performing teams. Qualified candidates must reside in Oklahoma.

Fundamental Components:
• Reinforces clinical philosophy, programs, policies and procedures.
• Communicates strategic plan and specific tactics to meet plan.
• Ensures implementation of tactics to meet strategic direction for cost and quality outcomes.
• Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results.
• Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
• Will be accountable for meeting the financial, operational and quality objectives of the unit.
• Will be accountable for the day-to-day management of team(s) for appropriate implementation and adherence with established practices, policies and procedures.
• Works closely with other functional area managers to ensure consistency in clinical interventions supporting our plan sponsors. • Develop, initiate, monitor and communicate performance expectations.
• May act as a single point of contact for the customer and the Account Team which includes participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
• Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills.
• Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams.
• Consistently demonstrates the ability to serve as a model change agent and lead change efforts.
• Accountable for maintaining compliance with policies and procedures and implements them at the employee level.
• Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.

Pay Range
The typical pay range for this role is:
Minimum: 84,500
Maximum: 182,000

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.

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

Required Qualifications
• Must reside in Oklahoma.
• Oklahoma-licensed RN or Mental Health Professional- Licensed Professional Counselor (LPC), Licensed Marriage & Family Therapist (LMFT), Licensed Behavioral Practitioner (LBP), or Licensed Clinical Social Worker (LCSW) with current unencumbered Oklahoma state license.
• 2+ Utilization review experience required.
• 5+ years of clinical practice experience in physical or behavioral healthcare.
• 2+ years managed care experience is required
• 2+ years of experience with personal computer, keyboard navigation, and MS Office Suite applications.
• 2+ years of healthcare management experience required (preferably in a managed care setting)
• Must possess reliable transportation and be willing and able to travel in-state up to 10% of the time. Mileage is reimbursed per our company expense reimbursement policy.
•Ability to work core business hours, Monday-Friday, 8am-5pm, with flexibility to work occasional weekend hours is required. Ability to provide on-call UM coverage for nights and weekends on a rotational schedule as required by the State regulatory agency.

Preferred Qualifications
• 5+ years’ managed care is preferred.
• Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
• Medicaid experience.
• If RN, BSN degree preferred.

Master’s Level of Education resulting in independent Behavioral Health licensure (LCSW, LPC, LMFT,) or Associate Degree or Nursing Diploma required for Registered Nurse (RN) with unrestricted state license in Oklahoma

Business Overview
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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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. 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.