Utilization Management Clinical Consultant

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

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 : 

 Licensed independent Behavioral Health clinician or a Registered Nurse (RN) with unrestricted state license with psychiatric specialty, certification, or 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 

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