Utilization Management Clinical Consultant
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Remote • Kentucky • 🇺🇸 United States
Visit company websiteSalary
💰 $26 - $56 per hour
Job Level
Mid-LevelSenior
About the role
- Applies critical thinking and is knowledgeable in clinically appropriate treatment
- 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 appropriate clinical criteria/guideline, policy, procedure and 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
- Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
- Consults and lends expertise to other internal and external constituents in coordination and administration of utilization/benefit management function
Requirements
- Must reside in Kentucky or bordering Counties
- Licensed independent behavioral health clinician with Kentucky state licensure (LCSW, LPCC, LMFT, LPAT)
- Registered Nurse (RN) with active and unrestricted Kentucky state license with psychiatric specialty or behavioral health experience or certification
- 3+ years clinical practice experience in behavioral health
- 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 outside of standard schedule based on business needs
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings
- Tobacco cessation and weight management programs
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical assessmentevidence-based practicetreatment planningutilization managementclinical criteria applicationhealthcare services coordinationreferral facilitationquality improvementbehavioral health experiencepsychiatric specialty
Soft skills
critical thinkingcollaborationcommunicationmultitaskingprioritizationadaptabilityconsultationproblem-solvingorganizational skillsinterpersonal skills
Certifications
LCSWLPCCLMFTLPATRegistered Nurse (RN)