Utilization Management Clinical Consultant - Must reside in Kentucky or Bordering State County

CVS Health • Kentucky, Kentucky • 4d ago

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

This is a fully remote Utilization Review Clinical Consultant. Must reside in the state of Kentucky or bordering State Counties

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.

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.

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.

Required Qualifications

Must reside in Kentucky or bordering state Counties

Licensed independent behavioral health clinician with Kentucky state licensure (LCSW, LPCC, LMFT, LPAT) or a Registered Nurse (RN) with active current and unrestricted Kentucky state license with psychiatric specialty, or behavioral health experience or certification

3+ years clinical practice experience in behavioral health, e.g., hospital setting, residential setting, or outpatient behavioral health setting

Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment

Willing and able to work Monday through Friday, 8am - 5pm EST with some flexibility to work outside of the standard schedule based on business needs

Preferred Qualifications

Managed care/utilization review experience

Experience in an inpatient behavioral health setting

Foster Care population experience

Proficiency with computer skills which includes navigating multiple systems and keyboarding

Experience using MS office applications including Teams, Outlook, Excel, and Word

Education

Master's Degree resulting in an Independent Clinical Behavioral Health licensure OR Minimum of an Associate's in nursing or Diploma RN for Registered Nurses

Anticipated Weekly Hours

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 05/08/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.

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