fication (Remote)Utilization Management Clinician Behavioral Health - Precertification (Remote) at CVS Health

United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

3+ years of behavioral health clinical experience in a hospital setting
Active, current, and unrestricted Master's Level Behavioral Health clinical license (LMSW, LCSW, LISW, LPC, or comparable) or Registered Nurse licensure in state of residence, with psychiatric experience
Ability to work Monday through Friday 12pm to 8:30pm EST
Master's degree in Behavioral/Mental health services with BH Licensure OR Associates Degree with Registered Nurse Licensure, BSN preferred
Proficiency with computer skills, including navigating multiple systems and keyboarding

Responsibilities

Coordinate, document, and communicate all aspects of the utilization/benefit management program
Apply critical thinking and knowledge of clinically appropriate treatment, evidence-based care, and clinical practice guidelines for Behavioral Health and/or medical conditions
Assess appropriateness of treatment plans across levels of care, applying evidence-based standards and practice guidelines
Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members
Provide triage and crisis report
Gather clinical information and apply clinical judgment to render coverage determination/recommendation
Coordinate with providers and other parties to facilitate optimal care/treatment
Identify members at risk for poor outcomes and facilitate referral opportunities
Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization
Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

Skills

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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