Utilization Management Clinician, Behavioral Health

This is a fully remote position, open to applicants in Alabama, +42 more states.

📋 Description

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

• Organize, document, and convey utilization management outcomes to providers and stakeholders.

• Handle crisis calls, assess risk levels, identify support needs, and coordinate suitable interventions.

• Elevate concerns related to suicide risk, self-harm, and welfare checks as necessary.

• Leverage clinical expertise to ensure quality, cost-effective care and promote positive member outcomes.

• Operate effectively in a fast-paced, queue-driven environment while juggling multiple priorities.

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

⛳️ Requirements

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

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

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

• Capability to manage telephonic and computer-based tasks effectively at the same time.

• High-speed residential internet service with a minimum of 25 Mbps download and 3 Mbps upload is required.

• Availability to work on holidays is essential.

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

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

• Experience in hospital-based behavioral health settings is preferred.

• Prior experience in Utilization Management or Prior Authorization is preferred.

• Experience in Managed Care is preferred.

🏝️ Benefits

• 12.5% shift differential.

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

• Comprehensive medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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