Utilization Management Clinical Consultant

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Position Summary

The Behavioral Health UM Clinician position is designed to clinically review of behavioral health prior authorized services for assigned members. This position’s responsibilities shall include, but are not limited to the following:

• 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.

• 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

Required Qualifications

• Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse (RN) with unrestricted Ohio state license with psychiatric specialty, certification, or experience. Must reside in the state of Ohio. 

•  3 years clinical practice experience, e.g., psychiatric hospital, residential or behavioral health treatment setting.

• 1 year Electronic Medical Record documentation experience

• Must be willing and able to work Monday-Friday, 8am to 5pm EST with flexibility to work outside of the standard schedule based on business needs, including occasional rotating weekend and holiday schedules. 

• Must reside in Ohio

• Willing and able to travel up to 10% of their time for onsite meetings and trainings to New Albany Office in OH.

Preferred Qualifications

• 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

 
Education
Master's Level of Education resulting in independent Behavioral Health licensure (LISW, LMFT, LPCC) or if a Registered Nurse Associates degree required and BSN preferred.
 

Pay Range

The typical pay range for this role is:

This 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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Salary : $26 - $56