Utilization Management Clinical Consultant - Must reside in Kentucky or bordering county

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

This is a fully remote Utilization Review Clinical Consultant. Must reside in the state of Kentucky or bordering Counties

• Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.  
• Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence-based standards and practice guidelines to treatment where appropriate. 
• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. 
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage.
• 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. 
•  Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.  

Required Qualifications

• Must reside in Kentucky or bordering Counties
• Licensed independent behavioral health clinician with Kentucky state licensure (LCSW, LPCC, LMFT, LPAT) or a Registered Nurse (RN) with active current and unrestricted Kentucky state license with psychiatric specialty, or behavioral health experience or certification 
• 3+ years clinical practice experience in behavioral health, e.g., hospital setting, residential setting, or outpatient behavioral health setting
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment 
• Willing and able to work Monday through Friday, 8am - 5pm EST with some flexibility to work outside of the standard schedule based on business needs 

  

Preferred Qualifications

• Managed care/utilization review experience 
• Foster Care population experience
• Proficiency with computer skills which includes navigating multiple systems and keyboarding
• Experience using MS office applications including Teams, Outlook, Excel, and Word

Education

• Master's Degree resulting in an Independent Clinical Behavioral Health licensure OR Minimum of an Associate's in Nursing or Diploma RN for Registered Nurses

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $56.14

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight managemen