Utilization Management Clinician, Behavioral Health

This is a fully remote position, open to applicants in Utah.

📋 Description

• Evaluate preauthorization requests for behavioral health services utilizing evidence-based guidelines and clinical judgment.

• Coordinate, document, and convey utilization management decisions to providers and stakeholders.

• Handle crisis calls and assess risk using clinical discernment.

• Identify support requirements and orchestrate suitable interventions, including escalation for suicide risk, self-harm issues, and welfare checks when necessary.

• Utilize clinical expertise to promote quality, cost-effective care and favorable member outcomes.

• Operate in a dynamic, queue-driven environment while juggling multiple priorities.

• Collaborate with providers and care teams to ensure appropriate levels of care are maintained.

• Availability to work Saturday and Sunday from 12pm to 10pm MT, and Thursday to Friday from 3pm to 1am MT.

• Commitment to a full-time schedule of 40 hours per week.

⛳️ Requirements

• Possession of an active, unrestricted independent behavioral health clinical license in the state of residence, such as LCSW, LICSW, LISW, LMSW, LPC, LMHC, LCMHC, LMFT, Clinical Psychologist, or RN.

• A minimum of 3 years of post-licensure experience in behavioral health.

• At least 3 years of experience dealing with mental health and substance use disorders.

• Capability to efficiently manage both telephonic and computer-based tasks simultaneously.

• High-speed residential internet connection with at least 25 Mbps download and 3 Mbps upload speeds.

• Availability to work during holidays.

• For Behavioral Health Clinicians: A Master's degree in Social Work, Counseling, or Psychology.

• For Registered Nurses: A Bachelor's degree in Nursing with a focus on Behavioral Health or Psychology.

• Preferred: Experience in a hospital-based behavioral health setting.

• Preferred: Background in Utilization Management or Prior Authorization.

• Preferred: Experience within Managed Care.

🏝️ Benefits

• 12.5% shift differential.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources promoting physical, emotional, and financial well-being.

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.