CVS Health

Utilization Management Clinical Consultant - Behavioral Health

Posted on

June 10, 2025

Job Type

Full-Time

Role Type

Behavioral Health

License

RN

State License

Compact / Multi-State

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Company Description

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.

Job Description

MUST HAVE LICENSURE IN KENTUCKY - SEE REQUIRED QUALIFICATIONS FOR LICENSING DETAILS This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna Better Health of Kentucky. This position will be utilized to provide multi-state coverage that will vary from day to day. The schedule is Monday-Friday, 8am-5pm with flexibility to work outside of the standard schedule based on business needs.

Requirements

Required Qualifications: Kentucky Licensed Independent Behavioral Health Clinician ( LPCC, LCSW, LMFT, LPAT ) - OR - Active unrestricted Compact Registered Nurse (RN) license with psychiatric specialty or behavioral health experience. 3+ years clinical practice experience in a behavioral health setting e.g., psychiatric hospital, residential, or behavioral health treatment setting 1+ year Electronic Medical Record documentation experience Dedicated High Speed Internet Access Preferred Qualifications: Residency in Kentucky or bordering counties Experience working with Substance Use Disorder diagnoses Managed care/utilization review experience Medicaid experience Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding Experience with MS office applications including Teams, Outlook, Word, and Excel Remote work experience Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment Education: Masters degree with a Behavioral Health Clinical License ( LPCC, LCSW, LMFT, LPAT) OR Minimum of a Diploma RN or Associate's degree in Nursing

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Responsibilities

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.

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