UM Clinical Consultant

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.

Schedule is Monday-Friday with flexibility to work outside of the standard schedule based on business needs 

 
LCSW, LCPC, RN with experience in psychiatric setting required. 

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.  

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. 
Provides triage and crisis support. 
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage. 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 : 

•  Unrestricted OK state independent Behavioral Health clinician
  license or a Registered Nurse (RN) with psychiatric specialty,
  certification, or Behavioral Health experience
• 3+ years clinical practice experience, e.g., psychiatric hospital,
  residential or behavioral health treatment setting. 
• 1+ year Electronic Medical Record documentation experience
• Must have reliable High Speed internet access
• Schedule is Monday-Friday with flexibility to work outside of the standard schedule based on business needs, including occasional rotating weekend and holiday schedules.

 Preferred Qualifications: 

•  Managed care/utilization review experience preferred

  Experience in a behavioral health inpatient setting

• Ability to multitask, prioritize and effectively adapt to a fast-paced
  changing environment

• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

Education : 

• Master's Level of Education resulting in independent Behavioral Health licensure (LCSW, LPCC, LMFT, LPAT, LP) or a Registered Nurse (RN) with unrestricted state license with psychiatric sp