Utilization Management Clinical Consultant - Behavioral Health

University of New Mexico Hospitals (UNMH); Frankfort (KY); Remote; Full time

Job summary

A leading healthcare company seeks a remote Utilization Management Clinical Consultant in Kentucky. The role requires a licensed healthcare professional to manage benefit programs, using clinical skills to evaluate treatment plans and coordinate care effectively. Ideal candidates will have extensive behavioral health experience and strong critical thinking skills.

Benefits

401(k) plan with matching contributions

Affordable medical plan options

Tuition assistance

Qualifications

• Kentucky Licensed Independent Behavioral Health Clinician or Active RN license with psychiatric specialty required.
• 3+ years clinical practice experience in a behavioral health setting.
• 1+ year Electronic Medical Record documentation experience.

Responsibilities

• Coordinate, document and communicate all aspects of the utilization/benefit management program.
• Assess appropriateness of treatment plans and apply evidence-based standards.
• Provide triage and crisis support and monitor options for healthcare services.

Skills

Critical Thinking

Clinical Assessment

Crisis Support

Education

Masters degree with a Behavioral Health Clinical License

Diploma RN or Associate's degree in Nursing

Tools

Electronic Medical Record

MS Office Suite

Job 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.

Position Summary

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.

• 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.

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

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$26.01 - $56.14

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 06/30/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.