Utilization Management Clinical Consultant

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

This is a fully remote Utilization Review Clinical Consultant with a schedule of Monday-Friday, 8am -5pm EST with flexibility to work outside of the standard schedule based on business needs, including some weekends

• 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.
• 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. 
•  Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.  

Required Qualifications

• Must reside in West Virginia
• Licensed independent behavioral health clinician with West Virginia state licensure (LCSW, LPCC, LMFT, LPAT) or a Registered Nurse (RN) with active current and unrestricted West Virginia state license or a compact license that covers West Virginia with behavioral health specialty, or behavioral health experience or certification 
• 3+ years clinical practice experience in behavioral health, e.g., hospital setting, residential setting, alternative care setting, or ambulatory care experience 
• Willing and able to work Monday-Friday, 8am-5pm EST with flexibility to work outside of the standard schedule based on business needs, including some weekends

Preferred Qualifications

• Managed care experience
• Utilization review experience 
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment 
• Proficiency with computer skills which includes navigating multiple systems and keyboarding
• Experience using MS office applications including Teams, Outlook, Excel, and Word

Education

• Master's Degree Behavioral Health/Social Work field OR Minimum of a Diploma or Associate's in Nursing for Registered Nurses

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 Benefits | CVS Health

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