Utilization Management Clinical Consultant - Behavioral Health

CVS Health; Lexington (KY); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading health solutions company seeks a Licensed Independent Behavioral Health Clinician to provide coordinated care and utilization management. Ideal candidates will hold a Kentucky license and have a strong background in behavioral health. This role offers competitive pay, flexible working conditions, and comprehensive benefits within an inclusive team environment.

Benefits

Comprehensive benefits including medical and 401(k)

Wellness programs including counseling and coaching

Flexible work schedules and paid time off

Remote working options

Qualifications

• Kentucky Licensed Independent Behavioral Health Clinician or active RN license with psychiatric specialty.
• Minimum of 3 years clinical practice experience in behavioral health setting.
• At least 1 year of Electronic Medical Record documentation experience.

Responsibilities

• Utilize clinical skills to coordinate and communicate utilization management program.
• Assess treatment plans using evidence-based standards.
• Provide crisis support and gather clinical information for coverage determinations.

Skills

Clinical Skills

Crisis Support

Team Collaboration

Education

Master's degree with a Behavioral Health Clinical License

Diploma RN or Associate's degree in Nursing

Tools

Electronic Medical Records

Microsoft Office

Job description

Employer Industry: Health Solutions Company

Why consider this job opportunity:
- Salary up to $56.14 per hour
- Eligible for bonuses, commissions, or short-term incentive programs
- Comprehensive benefits including affordable medical plan options, 401(k) with matching contributions, and employee stock purchase plan
- No-cost wellness programs including screenings, counseling, and financial coaching
- Flexible work schedules and paid time off options
- Opportunity to work remotely with a supportive and inclusive team

What to Expect (Job Responsibilities):
- Utilize clinical skills to coordinate and communicate all aspects of the utilization/benefit management program
- Assess appropriateness of treatment plans across levels of care using evidence-based standards
- Coordinate and evaluate options to facilitate appropriate healthcare services for members
- Provide triage and crisis support while gathering clinical information for coverage determinations
- Collaborate with providers and other parties to ensure optimal care and treatment

What is Required (Qualifications):
- Kentucky Licensed Independent Behavioral Health Clinician (LPCC, LCSW, LMFT, LPAT) or active unrestricted Compact Registered Nurse (RN) license with psychiatric specialty
- Minimum of 3 years clinical practice experience in a behavioral health setting
- At least 1 year of Electronic Medical Record documentation experience
- Dedicated high-speed internet access
- Master's degree with a Behavioral Health Clinical License or minimum of a Diploma RN or Associate's degree in Nursing

How to Stand Out (Preferred Qualifications):
- Residency in Kentucky or bordering counties
- Experience working with Substance Use Disorder diagnoses
- Managed care/utilization review experience
- Medicaid experience
- Proficiency in Microsoft Office applications including Teams, Outlook, Word, and Excel

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