Utilization Management Clinician, Behavioral Health – Autism Care Team

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

📋 Description

• Evaluate the suitability of treatment plans for ABA services based on evidence-based standards and clinical guidelines.

• Organize, monitor, and assess options to ensure that members receive appropriate healthcare services and benefits.

• Provide triage and crisis support as needed.

• Collect clinical information and utilize clinical criteria, policies, procedures, and professional judgment to make coverage decisions.

• Offer determinations and recommendations to providers throughout the continuum of care and assist with effective discharge planning.

• Collaborate with providers and other stakeholders to ensure optimal care and treatment.

• Identify members at risk for unfavorable outcomes and facilitate referrals to additional products, services, and programs.

• Conduct outreach to members to provide resources, education, answer inquiries, and offer referrals.

• Spot opportunities to enhance quality and effective utilization of healthcare services and benefits.

• Consult with both internal and external stakeholders regarding utilization and benefit management.

⛳️ Requirements

• A valid and unrestricted independent professional behavioral health clinical license is required in the state of residence; acceptable licenses include LPC, LMFT, LCSW, LCPC, LMHC, LCMHC, LICSW, LISW, LBS, LBA, or Clinical Psychologist.

• A minimum of 3 years of direct clinical practice experience following the master’s degree, in settings such as hospitals, ambulatory care, or outpatient clinics/facilities.

• At least 2 years of experience in crisis intervention.

• A minimum of 3 years of experience working with clients diagnosed with autism.

• Residential broadband service with internet speeds of no less than 25 Mbps download and 3 Mbps upload.

• A master’s degree in Behavioral/Mental Health or Human Service/Health Services.

• Preferred: prior experience in managed care.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Some candidates may qualify for partial reimbursement of residential broadband service.

• CVS Health bonus, commission, or short-term incentive program in addition to base pay.