Utilization Management Clinician, Behavioral Health

Other Jobs To Apply

Job Description:

  • Review and evaluate treatment plans across various levels of care against evidence-based standards, clinical guidelines, and benefit coverage criteria
  • Coordinate, monitor, and assess healthcare service options to support appropriate, cost-effective care
  • Collect and assess clinical information to make coverage recommendations, including discharge planning and transitions of care
  • Coordinate services for members with complex medical, behavioral health, and psychosocial needs
  • Collaborate with providers, care teams, and interdisciplinary partners to support optimal treatment outcomes and continuity of care
  • Identify high-risk members and connect them with internal programs, services, community resources, or additional supports
  • Identify opportunities to improve healthcare quality and effectiveness while optimizing benefit use
  • Serve as a clinical resource to internal teams and external partners on utilization management processes and member coordination requirements
  • Work primarily at a computer, including extended periods of phone communication
  • Report directly to the Medicare Concurrent UM Team

Requirements:

  • Must be able to work Monday-Friday, 8:30am-5:00pm; no weekends or holidays
  • Active, current, and unrestricted Registered Nurse licensure in the state of residence with psychiatric specialty, certification, or relevant experience
  • 1+ years of behavioral health utilization review/utilization management experience
  • 3+ years of experience in an inpatient hospital setting working with behavioral health members; experience must be recent or supported by continuous behavioral health-focused work
  • Ability to multitask, prioritize, and adapt effectively to a fast-paced changing environment
  • Ability to work independently
  • Associate degree required
  • Master’s-level behavioral health degree or Registered Nurse licensure with behavioral health experience
  • Active, current, and unrestricted Master’s-level behavioral health clinical license in the state of residence (LMSW, LCSW, LISW, LPC, or comparable), or Registered Nurse licensure in the state of residence with psychiatric specialty, certification, or relevant experience
  • Strong computer proficiency, including navigating multiple systems and accurate keyboarding (preferred)
  • Experience applying the Medicare Benefit Policy manual (preferred)
  • Experience working with geriatric or chronically mentally ill populations (preferred)
  • Experience supporting high-risk member populations (preferred)

Benefits:

  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs
  • Other resources supporting physical, emotional, and financial well-being
  • CVS Health bonus, commission or short-term incentive program in addition to base pay
Back to blog

Other Jobs To Apply

Remote Inside Sales Representative

Amazon Customer Service - Work From Home $16-$24/hr (East Meadow)

Salesforce Admin – United States – Remote

Online K-12 Tutor / Teacher - All Subjects (Remote)

High-Income Side Gig for Business-Minded Professionals (Remote)

Remote Personal Executive Assistant for Founder

Test Products from Home

Court Interpreter Expert, Legal AI Evaluation

Remote Healthcare Administrative Manager

Remote Data Scientist

Remote IP Coder

HMDA Compliance Specialist - To 75K - Remote - Job 3704B

Staff Product Manager, Ads Measurement at Pinterest: 100% Remote (New York, NY)

Virtual Clinician Home Evaluations Nurse Practitioner or Physician Assistant Full Time – Oregon

Founding Business Development Rep (BDR)

(EG0077) Marketo Specialist

Careercusp: FULL TIME Hulu Content Moderator $370/hours

Hobby Lobby Data Entry Jobs From Home Part Time...

Senior Engineer, Competitive Benchmarking & Performance (Remote)

Freelance Remote Bookkeeping Jobs: Apply Now!

Administrative Assistant / Data Entry Clerk (Remote Work From Home)

Litigation Associate - 100% Remote

QA Analyst for Remote

Commercial Counsel (Fully Remote – Project-Based Engagement)

Communications Writer - Entry Level, Remote

Care Manager / Case Mgr (RN) Remote (WA Pref) Must Have Compact Licensure

Catering Sales Representative, Roti

Vice President, Government Business Development Remote - US

Work From Anywhere Data Annotation Operator for AI Models

Threat Hunter, FedCloud (Remote)

Senior Lead Financial Planner

Seasonal Healthcare Trainer

Medical Coder – Remote (Worldwide)

Join Today: Remote Study Contributor – Flexible Work, High Pay

**Experienced Remote Live Chat Support Specialist – Evening Shift – Flexible Hours – Earn $25‑35/hr – Join reputed company**

Video Editor (Contractor - Part Time)

Virtual Assist - Auto Adjuster - Remote (MST/PST) (Colorado)

Senior Event Marketing Strategist (Remote, 40% Travel)

Property Intern

Program Integrity Manager, DentaQuest - Must Reside in Iowa

VIP Flight Specialist

Earn 19 plus per Hour - (Remote) Customer Service Representative

_ Entry-Level Work from Home Role | Simple Tasks | Start Anytime

Senior, Customer Success - Remote

Software Engineer – Remote (Worldwide)

Call Center Sales Representative at EchoStar: 100% Remote (Baton Rouge, LA)

Data Analyst I - UHC COVE Provider Experience - Remote

Remote Clinical Pharmacist - Formulary & Compliance

Graphic Designer – Remote (Worldwide)

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...