Behavioral Health UM 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.

SIGN ON BONUS - Qualifying candidates may be eligible for up to a $5,000 sign on bonus upon hire.

This is a full-time teleworker position in Oklahoma. Full-time schedule for this position is Tuesday-Saturday from 8-5pm CST.

The Behavioral Health Clinical Consultant 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 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, 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:

• Must reside in Oklahoma
• Oklahoma-licensed mental health professional- Licensed Professional Counselor (LPC), Licensed Marriage & Family Therapist (LMFT), Licensed Behavioral Practitioner (LBP), or Licensed Clinical Social Worker (LCSW) with current unencumbered license OR psychiatric RN with current unrestricted Oklahoma state licensure.
• 3+ years of clinical practice experience (e.g., hospital or behavioral health setting)
• 2+ years of experience using a personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
• 1+ year(s) of experience with electronic medical records
• Willing and able to provide on-call UM coverage for nights and weekends on a rotational schedule as required by the State regulatory agency.

Preferred Qualifications:

• Experience working in the Oklahoma Medicaid Health system *strongly preferred*.
• Managed care/utilization review experience strongly preferred.
• Claims review experience strongly preferred
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment

Education:

• If RN, Associate's degree or nursing diploma required; BSN preferred.
• If BH licensed, minimum of a master’s degree in behavioral health field required (e.g., counseling, marriage & family therapy, or social work).

Pay Range

The typical pay range for this role is:

$25.25 - $54.50

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provid