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 is a fulltime remote Utilization Management Clinical Consultant opportunity. Schedul e is Monday-Friday, 8am-5pm EST with flexibility to work outside of the standard schedule based on business needs.

• 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 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

• Licensed Independent Behavioral Health clinician or a Registered Nurse (RN) with unrestricted state license with psychiatric specialty or behavioral health experience
• 3+ years clinical practice experience in behavioral health e.g., psychiatric hospital , residential or behavioral health treatment setting
• 1+ years' experience using MS office applications such as Teams, Outlook, Excel, and Word; proficiency with computer skills which includes navigating multiple systems and keyboarding.
• 1+ year electronic medical record documentation experience
• Schedule is Monday-Friday, 8am-5pm EST with flexibility to work outside of the standard schedule based on business needs , including occasional rotating weekend and holiday schedules

• Managed care/utilization review experience
• Experience in a behavioral health inpatient and outpatient setting
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment

• Masters Level Education resulting in a Behavioral Health Clinical License OR Minimum of a Diploma RN or Associate's degree in Nursing

• 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.