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Utilization Management Clinical Consultant
Location
Idaho + 3 moreAll locations: Idaho | New Jersey | Texas | Vermont
Posted
108 days ago
Salary
$32 - $68 / hour
Seniority
Senior
Job Description
Utilization Management Clinical Consultant
CVS Health
• 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 facilitating 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
Job Requirements
- Licensed independent Behavioral Health clinician or a Registered Nurse (RN) with unrestricted state license with psychiatric specialty, certification, or experience
- 3+ years clinical practice experience, e.g., psychiatric hospital, residential or behavioral health treatment setting
- 1+ year Electronic Medical Record documentation experience
- Must have reliable High Speed internet access
- Schedule is Monday-Friday with flexibility to work outside of the standard schedule based on business needs, including occasional rotating weekend and holiday schedules
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- Wellness screenings
- Tobacco cessation programs
- Weight management programs
- Confidential counseling
- Financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
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