Utilization Management Clinical Consultant

Job Description
This is a fully remote Monday-Friday position, standard business hours, 8:00am-5:00pm EST or 7:00am-4:00pm CST. Candidates may reside anywhere within the State of Kentucky. Licensed independent Behavioral Health clinician in Kentucky (LCSW, LPCC, LMFT, LPAT, or LP) required.

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services.

- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

- Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care.

- Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support).

- Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment.

- Identifies members who may benefit from care management programs and facilitates referral.

- Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.

Required Qualifications
- Licensed independent Behavioral Health clinician in state of service (LCSW, LPCC, LMFT, LPAT, or LP) required.

- 3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.

- 1+ year experience proficiency with computer skills which includes navigating multiple systems and keyboarding required.

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
- Managed care/utilization review experience preferred.

- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment while working in a phone queue.

Education
Master's Level of Education resulting in independent Behavioral Health licensure (LCSW, LPCC, LMFT, LPAT, or LP)

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.