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CVS Health · 2 days ago

Utilization Management Clinical Consultant (Tuesday - Saturday)

United States

Full-time

Remote

Mid Level

$26.01/hr - $56.14/hr

3+ years exp

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care for millions of Americans. The Utilization Management Clinical Consultant role involves utilizing clinical skills to coordinate and manage healthcare services for members, applying evidence-based standards in treatment plans, and providing crisis support while collaborating with healthcare providers.

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Responsibilities

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

Qualification

LCSWRN LicenseClinical Practice ExperienceElectronic Medical RecordBehavioral Health KnowledgeManaged Care ExperienceMultitaskingComputer Skills

Required

Independent Behavioral Health clinician License or an Unrestricted Registered Nurse (RN) License either within the state of LA or Compacted with psychiatric specialty 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

Work Schedule is Tuesday – Saturday, 8am – 5pm CST. Must have flexibility to work outside of the standard schedule based on business needs, including occasional rotating weekend and holiday schedules

Master's Level of Education resulting in independent Behavioral Health licensure (LCSW, LPCC, LMFT, LPAT, LP) or a Bachelor's Level of Education resulting in a Registered Nurse (RN) with an unrestricted state license with psychiatric specialty or experience

Preferred

Prefers someone who resides in Louisiana

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

Benefits

Affordable medical plan options

A 401(k) plan (including matching company contributions)

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.