CVS Health · 12 hours ago
Utilization Management Clinical Consultant - Must reside in Kentucky or bordering county
United States
Full-time
Remote
Mid Level
$26.01/hr - $56.14/hr
3+ years expCVS Health is building a world of health around every individual, seeking to simplify healthcare for communities. The Utilization Management Clinical Consultant will apply clinical expertise to assess treatment plans, coordinate healthcare services, and promote quality effectiveness of services.
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Responsibilities
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
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
Qualification
Required
Must reside in Kentucky or bordering Counties
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 with psychiatric specialty, or behavioral health experience or certification
3+ years clinical practice experience in behavioral health, e.g., hospital setting, residential setting, or outpatient behavioral health setting
Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
Willing and able to work Monday through Friday, 8am - 5pm EST with some flexibility to work outside of the standard schedule based on business needs
Master's Degree resulting in an Independent Clinical Behavioral Health licensure OR Minimum of an Associate's in Nursing or Diploma RN for Registered Nurses
Preferred
Managed care/utilization review experience
Foster Care population experience
Proficiency with computer skills which includes navigating multiple systems and keyboarding
Experience using MS office applications including Teams, Outlook, Excel, and Word
Benefits
Affordable medical plan options
A 401(k) plan (including matching company contributions)
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
Company
CVS Health
CVS Health is a health solutions company that provides an integrated healthcare services to its members.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$4BKey Investors
Michigan Economic Development CorporationStarboard Value
2025-08-15Post Ipo Debt· $4B
2025-07-17Grant· $1.5M
2019-11-25Post Ipo Equity
Leadership Team
David Joyner
President and Chief Executive Officer, CVS Health
Chandra McMahon
SVP & CISO
Recent News
2026-01-25
Company data provided by crunchbase