Utilization Management Clinical Consultant - Remote Kentucky

CVS Health • Frankfort, KY

412d • $54,101 - $116,771 • Remote

About The Position

The Utilization Management Clinical Consultant is a fully remote position based in Kentucky, responsible for coordinating and managing the utilization and benefit management program. This role requires clinical expertise to assess treatment plans, apply evidence-based standards, and facilitate optimal healthcare services for members. The consultant will also provide triage and crisis support, ensuring effective communication and collaboration with providers and other stakeholders.

Requirements

• Licensed independent Behavioral Health clinician with Kentucky state licensure (LCSW, LPCC, LMFT, LPAT, LP) or a Registered Nurse (RN) with active Kentucky state license and psychiatric specialty, certification, or experience.
• 3+ years of clinical practice experience in a psychiatric hospital, residential, or behavioral health treatment facility.
• Willingness to work Monday through Friday 8am - 5pm EST with some weekend work and flexibility based on business needs.
• Must reside in the state of Kentucky.

Nice To Haves

• Managed care/utilization review experience preferred.
• Experience in a behavioral health inpatient setting.
• Ability to multitask, prioritize, and adapt to a fast-paced changing environment.
• Proficiency with computer skills, including navigating multiple systems and keyboarding.

Responsibilities

• Utilize clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Apply critical thinking and knowledge of clinically appropriate treatment and evidence-based care for Behavioral Health and medical conditions.
• Assess appropriateness of treatment plans across levels of care and apply evidence-based standards and practice guidelines.
• Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Provide triage and crisis support as needed.
• Gather clinical information and apply appropriate clinical criteria, guidelines, and clinical judgment to render coverage.
• Coordinate with providers and other parties to facilitate optimal care/treatment.
• Identify members at risk for poor outcomes and facilitate referral opportunities to integrate with other products, services, and programs.
• Promote quality effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to internal and external constituents in the utilization/benefit management function.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan.
• Fully-paid term life insurance plan.
• Short-term and long-term disability benefits.
• Well-being programs and education assistance.
• Free development courses.
• CVS store discount and discount programs with participating partners.
• Paid Time Off (PTO) and paid holidays.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Health and Personal Care Retailers
• Education Level: Master's degree