Remote Utilization Management Clinician – Behavioral Health, PA

CVS Health

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Job ID: 2516800BR
Category: Nurse
Remote: Fully Remote

Job Description
Fully remote role in the USA.
Monday-Friday 8:30-5pm EST. No weekends or holidays.

-Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care an clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.
– 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 guideline to treatment where appropriate.
– Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
– Provides triage and crisis report.
– Gathers clinical information and applies the appropriate clinical judgment to render coverage determination/recommendation along the continuum of care facilities 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.
– Work requires sitting for extended periods, talking on the telephone and typing on the computer.

Pay Range
The typical pay range for this role is:
Minimum: 58,760
Maximum: 125,840

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
-3+ years of behavioral health clinical experience in a hospital setting required
-1+ years of utilization review/utilization management required
– One of the following is required: Unencumbered Master’s Level Behavioral Health clinical license in the state where they work (LMSW, LCSW, LISW, LPC, etc) or Registered Nurse that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all non-compact states.

-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
– Experience working with geriatric population
– Crisis intervention skills preferred.
– Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
– Managed care preferred

Master’s degree Behavioral/Mental Health services or Associates Nursing-Registered Nurse with Behavioral Health experience/background

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.