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CVS Health Utilization Management Clinical Consultant (LCSW, LPCC, LMFT, RN) in Kentucky

Job Description

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services.Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management functionGathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care.Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment.Identifies members who may benefit from care management programs and facilitates referralIdentifies opportunities to promote quality effectiveness of healthcare services and benefit utilization

Required Qualifications

3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding requiredLicensed independent Behavioral Health clinician in state of service (LCSW, LPCC, LMFT, LPAT, LPCC) or a Registered Nurse (RN) with unrestricted KY state license with psychiatric specialty, certification, or experience.

Preferred Qualifications

Managed care/utilization review experience preferred.Ability to multitask, prioritize and effectively adapt to a fast paced changing environment preferred


Master's Level of Education resulting in independent Behavioral Health licensure (LCSW, LPCC, LMFT, LPAT, LP) or a Registered Nurse (RN) with unrestricted KY state license with psychiatric specialty, certification, or experience.

Business Overview

At Coram, a CVS Health business, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.