Behavioral Health Clinical Consultant

Job not on LinkedIn

🔥 10 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $26 - $68 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Coordinate, document, and communicate all aspects of the utilization/benefit management program for Medicare Integrated/dually eligible member populations • Apply clinical expertise to review and evaluate treatment plans across various levels of care • Ensure alignment with evidence-based standards, clinical guidelines, and applicable benefit coverage criteria • Coordinate, monitor, and assess healthcare service options for appropriate, cost-effective care • Collect and assess clinical information to determine coverage recommendations • Support discharge planning, transitions of care, and coordination of services for members with complex needs • Collaborate with providers, care teams, and interdisciplinary partners to facilitate treatment outcomes and continuity of care • Identify high-risk members and connect them with internal programs, services, community resources, or additional supports • Enhance healthcare service quality and effectiveness while optimizing benefit use • Serve as a clinical resource to internal teams and external partners regarding utilization management processes and member needs • Perform responsibilities primarily at a computer, including extended periods of phone communication

🎯 Requirements

• Must be able to work Sunday–Thursday, 8:00am–4:30pm Eastern Time • Active, current, and unrestricted Master’s-level behavioral health clinical license in the state of residence (e.g., LMSW, LCSW, LISW, LPC, or comparable), or Registered Nurse licensure in the state of residence with psychiatric specialty, certification, or relevant experience • 1+ years of behavioral health utilization review/utilization management experience • 3+ years of experience in an inpatient hospital setting working with behavioral health members • Inpatient behavioral health experience must be recent, or supported by continuous behavioral health-focused work since the inpatient setting experience • Master’s degree in a behavioral health field, or Registered Nurse degree • Strong computer proficiency, including navigating multiple systems and accurate keyboarding • Experience rendering decisions within mandated turnaround times and working with limited schedule flexibility

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility • CVS Health bonus, commission or short-term incentive program in addition to base pay

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