CVS Health

Bringing our heart to every moment of your health.

Utilization Management Clinical Consultant

ConsultantConsultantFull TimeRemoteTeam 10,001+Since 1963H1B No SponsorCompany SiteLinkedIn

Location

Idaho + 3 moreAll locations: Idaho, New Jersey, Texas, Vermont

Posted

10 days ago

Salary

$32 - $68 / hour

Postgraduate Degree3 yrs expExperience acceptedEnglish

Job Description

• 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 facilitating 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

Job Requirements

  • Licensed independent Behavioral Health clinician or a Registered Nurse (RN) with unrestricted state license with psychiatric specialty, certification, or 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

Benefits

  • Affordable medical plan options
  • 401(k) plan (including matching company contributions)
  • Employee stock purchase plan
  • Wellness screenings
  • Tobacco cessation programs
  • Weight management programs
  • Confidential counseling
  • Financial coaching
  • Paid time off
  • Flexible work schedules
  • Family leave
  • Dependent care resources
  • Colleague assistance programs
  • Tuition assistance
  • Retiree medical access

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