Behavioral Health - Utilization Management Clinical Consultant
CVS Health
Frankfort, KYPosted Discovered via the company's careers siteMatch locked
Remote3+ years expManagement
About the role
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.
Position Summary
This Clinical Consultant position is with Aetna's Utilization Management (UM) team and is a work from home anywhere in the United States. The requirements is for candidates to hold a Behavioral health clinician or Registered Nursing with Kentucky state or compact licensure.The work scheduled will be Sunday - Thursday, 8:00am - 5:00pm EST • 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.
- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
Required Qualifications
- Licensed independent behavioral health clinician with Kentucky state licensure (LCSW, LPCC, LMFT, LPAT) or a Registered Nurse (RN) with active current and unrestricted Kentucky state license or a compact license that covers Kentucky with psychiatric specialty, or behavioral health experience or certification
- 3+ years clinical practice experience in behavioral health, e.g., hospital setting, residential setting, alternative care setting, or outpatient care exp.
- Willing and able to work Sunday - Thursday, 8am - 5pm EST with some flexibility to work outside of the standard schedule based on business needs
Preferred Qualifications
- Managed care/utilization review experience
- Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
- Proficiency with computer skills which includes navigating multiple systems and keyboarding
- Experience using MS office applications including Teams, Outlook, Excel, and Word
Education
- Master's Degree in Social Work/Behavioral Health field OR Minimum of a Diploma or Associate's in Nursing for Registered Nurses
Full time Pay Range
The typical pay range for this role is:$26.01 - $56.14This 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: •
Affordable medical plan options,
a
401(k) plan
(including matching company contributions), and an
employee stock purchase plan
.
•
No-cost programs for all colleagues
including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
•
Benefit solutions that address the different needs and preferences of our colleagues
including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 05/04/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Not included in the source posting: about the role.
Skills
excel
Who can apply
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