Behavioral Health Utilization Management Clinical Consultant - Work at Home - Oklahoma

CVS Health • Tulsa, OK

26d • $26 - $56 • Remote

About The Position

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. Work at home Position-Must Reside in Oklahoma Position Summary: Behavioral Health Clinical Reviewer (LCSW, LCPC, RN) Licensed clinical professional with a passion for behavioral health and a strong background in psychiatric care. As a Behavioral Health Clinical Reviewer , your expertise will drive impactful decisions that improve lives. In this role, you’ll leverage your clinical skills to coordinate, document, and communicate all aspects of our utilization and benefit management programs. You’ll apply critical thinking and evidence-based guidelines to assess treatment plans, ensure appropriate levels of care, and promote quality healthcare outcomes.

Requirements

• Active licensure as LCSW, LCPC, or RN.
• Experience in a psychiatric or behavioral health setting required.
• Strong knowledge of clinical practice guidelines and utilization management.
• Unrestricted OK state independent Behavioral Health clinician license or a Registered Nurse (RN) with psychiatric specialty, certification, or Behavioral Health 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.

Nice To Haves

• 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

Responsibilities

• Evaluate treatment plans using clinical judgment and evidence-based standards.
• Coordinate and monitor healthcare services to ensure optimal benefit utilization.
• Provide triage and crisis support for members in need.
• Facilitate effective discharge planning and care transitions.
• Collaborate with providers and internal teams to support integrated care.
• Identify at-risk members and connect them with appropriate resources.
• Promote quality and cost-effective care through clinical consultation and review.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees