Utilization Management Clinician Behavioral Health - Precertification (Remote)

Lehigh University; Harrisburg (Dauphin County); Remote; USD 60,000 - 130,000; Full time

Job summary

A prominent health solutions company is hiring a Utilization Management Clinician for their Medicare precertification team. This remote full-time position involves assessing treatment plans, coordinating care, and improving healthcare service effectiveness, reflecting the company's commitment to compassionate care. Ideal candidates will have substantial behavioral health experience and required licensure.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings and financial coaching

Flexible work schedules

Tuition assistance

Qualifications

• 3+ years behavioral health clinical experience
• Active Master's Level Behavioral Health clinical license or RN licensure with psychiatric specialty
• Ability to work Monday-Friday 9 am-5:30 pm EST

Responsibilities

• Assess treatment plans for outpatient Medicare services and render decisions based on clinical judgment.
• Coordinate with providers for optimal patient care and identify members at risk for poor outcomes.
• Work with Clinical Supervisor and Medical Directors to facilitate care.

Skills

Crisis intervention skills

Managed care experience

Knowledge of Transcranial Magnetic Stimulation (TMS)

Education

Master's degree in Behavioral/Mental Health Services

Associate's degree for RN candidates

BSN preferred for RN candidates

Job description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

This is a full-time, remote position. The Medicare Behavioral Health Outpatient clinician will be part of the Medicare precertification team. Members of this team will utilize their clinical experience to assess appropriateness of treatment plans for members accessing outpatient services. This team will gather clinical information and apply appropriate clinical judgment to render coverage determination/recommendation that are in line with evidence-based standards and practice guidelines.

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.

The Utilization Management Clinician will work in conjunction with the Clinical Supervisor and Medical Directors to facilitate optimal care/treatment.

Schedule:

Monday-Friday 9-:00 AM-5:30 PM EST. No holidays and no weekends.

Required Qualifications

• 3+ years of behavioral health clinical experience
• Must have active current and unrestricted Master's Level Behavioral Health clinical license in the state of residence (LMSW, LCSW, LISW, LPC, or comparable) OR Registered Nurse licensure with psychiatric specialty, certification, or experience in state of residence
• Must be able to work Monday through Friday 9am-5:30pm EST

Preferred Qualifications

• Experience working with Medicare population
• Crisis intervention skills
• Managed care experience
• Knowledge of Transcranial Magnetic Stimulation (TMS)

Education

• Master's degree required if social worker, MSW, LCSW, Behavioral /mental health services
• For Registered Nurse candidates an Associates degree is required. BSN preferred

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$60,522.00 - $129,615.00

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 07/18/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.