Utilization Management Clinician Behavioral Health Autism

Fully remote in the USA.
Standard business hours 8am-5pm central/mountain time zone.
No weekends and no holidays.

• Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.
• Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning.
• Coordinates with providers and other parties to facilitate optimal care/treatment.
• Provides triage and crisis support.
• 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.
• Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans for ABA levels of care, apply evidence based standards and practice guidelines to treatment where appropriate.

Pay Range
The typical pay range for this role is:
Minimum: 58,760
Maximum: 125,840
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications

• An active, unrestricted Independent Behavioral Health license (LCSW, LPC, LMFT, LMHC, LBA, LBS or Psychologist) or Registered Nurse with 3 years of behavioral health experience 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.

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

• 3+ years of autism/ABA (applied behavior analysis) experience

• 3 years experience working with children in a clinical setting

• Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing into the computer

• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

Preferred Qualifications
Utilization Management experience
Managed care experience (MCO)
BCBA
3+ years of crisis intervention skills
Education
Minimum of a Master's degree in Behavioral/Mental health or Human Service/Health Services
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.