Medicare Behavioral Health Outpatient Utilization Management Clinician

Are you passionate about improving access to quality healthcare services for Medicare beneficiaries? Do you have a background in behavioral health and a desire to make a positive impact on people's lives? CVS Health is seeking a highly motivated and experienced clinician to join our team as a Medicare Behavioral Health Outpatient Utilization Management Clinician. In this role, you will play a crucial role in ensuring that our Medicare members receive appropriate and timely behavioral health services. As a trusted member of our healthcare team, you will have the opportunity to use your clinical expertise to promote the well-being of our members while also contributing to the overall success of our organization. If you possess a strong understanding of Medicare guidelines, excellent communication skills, and a drive to deliver exceptional care, we encourage you to apply for this exciting opportunity.

Conduct utilization management reviews of Medicare behavioral health services to ensure appropriateness, quality, and timeliness of care.
Collaborate with healthcare providers and interdisciplinary teams to develop individualized care plans for Medicare members.
Monitor and track utilization trends and provide recommendations for improvements in service delivery and cost savings.
Stay up-to-date on Medicare guidelines and policies and ensure compliance with all regulations.
Communicate effectively with members, providers, and internal teams to facilitate the timely delivery of behavioral health services.
Utilize clinical expertise to assess and manage the behavioral health needs of Medicare members.
Identify and escalate potential quality of care issues and participate in quality improvement initiatives.
Serve as a point of contact for members and their families to address any questions or concerns related to behavioral health services.
Monitor and report on key performance metrics related to utilization management and outcomes.
Maintain accurate and timely documentation of all utilization management activities.
Participate in interdisciplinary team meetings and provide clinical input and recommendations.
Assist in the development and implementation of new programs and initiatives to improve access to quality behavioral health services for Medicare members.
Collaborate with external stakeholders, including government agencies and community organizations, to promote the well-being of Medicare members.
Act as a liaison between members, providers, and internal teams to ensure the seamless delivery of behavioral health services.
Continuously evaluate and improve utilization management processes to enhance the overall member experience.

CVS Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

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