Utilization Management Clinical Consultant

Bring your heart to CVS Health. Every 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.

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

Hours: M-F, 8am - 5pm EST

•  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.

• 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 :  

• Licensed independent Behavioral Health clinician with Kentucky state licensure (LCSW, LPCC, LMFT, LPAT, LP) or a Registered Nurse (RN) with active current and unrestricted Kentucky state license with psychiatric specialty, certification, or experience 

• 3+ years clinical practice experience, e.g., psychiatric hospital, residential or behavioral health treatment facility

•  Must be able to work Monday through Friday 8am - 5pm EST with some weekend work and flexibility to work outside of the standard schedule based on business needs 

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 

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