CVS Health
Utilization Management Clinical Consultant - must reside in Ohio
CVS Health, Columbus, Ohio, United States, 43224
Utilization Management Clinical Consultant - must reside in Ohio
Join to apply for the
Utilization Management Clinical Consultant - must reside in Ohio
role at
CVS Health Utilization Management Clinical Consultant - must reside in Ohio
3 days ago Be among the first 25 applicants Join to apply for the
Utilization Management Clinical Consultant - must reside in Ohio
role at
CVS Health Get AI-powered advice on this job and more exclusive features. 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
The Behavioral Health UM Clinician position is designed to clinically review of behavioral health prior authorized services for assigned members. This position’s responsibilities shall include, but are not limited to the following:
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. 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
Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse (RN) with unrestricted Ohio state license with psychiatric specialty, certification, or experience. Must reside in the state of Ohio. 3+ years clinical practice experience, e.g., psychiatric hospital, residential or behavioral health treatment setting. 1+ year Electronic Medical Record documentation experience Must be willing and able to work Monday-Friday, 8am to 5pm EST with flexibility to work outside of the standard schedule based on business needs, including occasional rotating weekend and holiday schedules. Must reside in Ohio Willing and able to travel up to 10% of their time for onsite meetings and trainings to New Albany Office in OH.
Preferred Qualifications
Managed care/utilization review experience preferred Experience in a behavioral health inpatient setting Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Education
Master's Level of Education resulting in independent Behavioral Health licensure (LISW, LMFT, LPCC) or if a Registered Nurse Associates degree required and BSN preferred.
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: 08/31/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
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Join to apply for the
Utilization Management Clinical Consultant - must reside in Ohio
role at
CVS Health Utilization Management Clinical Consultant - must reside in Ohio
3 days ago Be among the first 25 applicants Join to apply for the
Utilization Management Clinical Consultant - must reside in Ohio
role at
CVS Health Get AI-powered advice on this job and more exclusive features. 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
The Behavioral Health UM Clinician position is designed to clinically review of behavioral health prior authorized services for assigned members. This position’s responsibilities shall include, but are not limited to the following:
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. 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
Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse (RN) with unrestricted Ohio state license with psychiatric specialty, certification, or experience. Must reside in the state of Ohio. 3+ years clinical practice experience, e.g., psychiatric hospital, residential or behavioral health treatment setting. 1+ year Electronic Medical Record documentation experience Must be willing and able to work Monday-Friday, 8am to 5pm EST with flexibility to work outside of the standard schedule based on business needs, including occasional rotating weekend and holiday schedules. Must reside in Ohio Willing and able to travel up to 10% of their time for onsite meetings and trainings to New Albany Office in OH.
Preferred Qualifications
Managed care/utilization review experience preferred Experience in a behavioral health inpatient setting Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Education
Master's Level of Education resulting in independent Behavioral Health licensure (LISW, LMFT, LPCC) or if a Registered Nurse Associates degree required and BSN preferred.
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: 08/31/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Research, Analyst, and Information Technology Industries Hospitals and Health Care Referrals increase your chances of interviewing at CVS Health by 2x Get notified about new Clinical Consultant jobs in
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We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr