Utilization Management Clinical Consultant (Must reside in Ohio)

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 This Clinical Consultant position is with Aetna’s Utilization Management (UM) team and is a field-based/Remote position out of the state of Ohio. The requirements is for candidates to hold a Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse (RN) with unrestricted state license in Ohio, and travel up to 10% of the time for onsite meetings. Schedule is Monday-Friday, 8am - 5pm EST with flexibility to work outside of the standard schedule based on business needs including occasional rotating weekend and holiday schedules. 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

• Must reside in the state of Ohio
• Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse (RN) with unrestricted state license in Ohio
• 3+ years clinical practice experience, e.g., psychiatric hospital, residential or behavioral health treatment setting
• 1+ years electronic medical record documentation experience
• 1+ years proficiency with computer skills which includes navigating multiple systems and keyboarding
• Schedule is Monday-Friday, 8am-5pm EST with flexibility to work outside of the standard schedule based on business needs, including occasional rotating weekend and holiday schedules

Preferred Qualifications

• Utilization review experience strongly preferred
• Behavioral health experience
• Experience in a behavioral health inpatient setting
• Managed care experience
• Utilization review experience
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment

Education

• Masters Level Education resulting in a Behavioral Health Clinical License 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: 06/23/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply Job!