Behavioral Health Utilization Specialist

CVS Health; Utah; Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Bonus program

Job summary

CVS Health is seeking a licensed behavioral health clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program. The role supports child/adolescent members and requires Arizona licensure and a 40-hour workweek.

You will collaborate with providers and internal teams, assess medical necessity, and refer members to care management as appropriate. Travel up to 10% may be required; weekend/holiday coverage as needed.

Qualifications

• 2+ years of behavioral health experience.
• Active and good standing Arizona clinical and/or counseling license (RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW).
• Willingness to work 8am-5pm (Arizona Time), and occasional weekends/holidays as needed.
• Willingness to travel up to 10% of the time within the United States.
• Previous experience working within the mental health system.
• Knowledge of behavioral health outpatient services.
• Ability to collaborate with various internal departments.
• Strong communication skills.

Responsibilities

• Coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Apply clinical knowledge to determine medical necessity criteria for utilization of services.
• Consult with internal and external constituents in the coordination and administration of utilization/benefit management.
• Gather clinical information and apply medical necessity criteria to render coverage decisions.
• Collaborate to evaluate and facilitate appropriate healthcare services/benefits for members, including urgent interventions.
• Coordinate and communicate with providers to facilitate optimal care.
• Identify members who may benefit from care management and referrals.
• Identify opportunities to promote quality and effectiveness of healthcare services and utilization.
• Sedentary work involving periods of sitting, talking, and listening.

Skills

Behavioral health experience

Strong communication skills

Time management

Collaboration

Education

Masters-level clinician or RN, licensed in AZ

Job description

CVS Health is seeking a licensed behavioral health clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program. The role supports child/adolescent members and requires Arizona licensure and a 40-hour workweek.

You will collaborate with providers and internal teams, assess medical necessity, and refer members to care management as appropriate. Travel up to 10% may be required; weekend/holiday coverage as needed.