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.

• 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

• 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

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