UM Clinician BH

Job Description Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans for ABA levels of care, apply evidence based standards and practice guidelines to treatment where appropriate. Coordinate, monitor and evaluate options to facilitate appropriatehealthcare services/benefits for members. Provides triage and crisis support. Gathers clinical information and applies the appropriate clinicalcriteria/guideline, policy, procedure and clinical judgment to rendercoverage. determination/recommendation along the continuum of care facilitates including effective discharge planning. Coordinates with providers and other parties to facilitate optimal care/treatment. Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs. Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.Required Qualifications 3-5 years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility- ABA experience preferred Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing into the computer Crisis intervention skills Position requires proficiency with computer skills which includes navigating multiple systems and keyboardingCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Managed care/utilization review experience preferredEducation Unencumbered Behavioral Health clinical license in the state where they work Minimum of a Master's degree in Behavioral/Mental health or HumanService/Health Services (as applicable to hiring program)Business OverviewBring your heart to CVS HealthEvery 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-10-04