Medicare Behavioral Health Outpatient Utilization Management Clinician (Bilingual, Remote)

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose : Bringing our heart to every moment of your health.

This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

This is a full-time telework position.

Hours for this role are Monday-Friday 8 : 30a-5 : 00p EST.

Position Summary

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 member 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.

The UM clinician will work in conjunction with the Clinical Supervisor and Medical Directors to facilitate optimal care / treatment.

Required Qualifications

• 1+ year(s) experience working in community based mental health service like Targeted Care Management, Psychosocial Rehabilitation, or related utilization management experience with these services
• Must have active and unrestricted independent Master's level Behavioral Health clinical license in the state of residence (LMSW, LCSW, LISW, LPC, or comparable) OR active and unrestricted Registered Nurse licensure with psychiatric specialty / certification in state of residence
• Must be willing and able to work 8 : 30a-5p EST
• Bilingual English / Spanish

Preferred Qualifications

Knowledge of Milliman Care Guidelines (MCG)

Education

Minimum of a Master's degree Behavioral / mental health services OR RN degree or diploma with behavioral health experience

Pay Range

The typical pay range for this role is :

$54,095.60 - $116,800.00

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.

The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.

The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits.

CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.

As for time off, Company employees enjoy Paid Time Off ( PTO ) or vacation pay, as well as paid holidays throughout the calendar year.

Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.