Behavioral Health - Utilization Management Clinical Consultant

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.Position Summary This Clinical Consultant position is with Aetna's Utilization Management (UM) team and is a work from home anywhere in the United States. The requirements is for candidates to hold a Behavioral health clinician or Registered Nursing with Kentucky state or compact licensure.The work scheduled will be Sunday - Thursday, 8:00am - 5:00pm EST

• 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.

• Licensed independent behavioral health clinician with Kentucky state licensure (LCSW, LPCC, LMFT, LPAT) or a Registered Nurse (RN) with active current and unrestricted Kentucky state license or a compact license that covers Kentucky with psychiatric 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 outpatient care exp.
• Willing and able to work Sunday - Thursday, 8am - 5pm EST with some flexibility to work outside of the standard schedule based on business needs

• Managed care/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

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

• 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.