CVS Health

UM Clinical Consultant

Oklahoma, United States

Not SpecifiedCompensation
Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Health InsuranceIndustries

Requirements

Candidates must possess an unrestricted Oklahoma state independent Behavioral Health clinician license (LCSW, LPCC, LMFT, LPAT, LP) or an unrestricted Registered Nurse (RN) license with psychiatric specialty, certification, or experience. A Master's degree is required for independent licensure. A minimum of 3 years of clinical practice experience in a psychiatric hospital, residential, or behavioral health treatment setting is necessary, along with at least 1 year of Electronic Medical Record documentation experience. Reliable high-speed internet access is mandatory. Flexibility to work outside standard hours, including occasional rotating weekends and holidays, is expected. Preferred qualifications include managed care/utilization review experience and experience in a behavioral health inpatient setting.

Responsibilities

The UM Clinical Consultant will utilize clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. This role involves applying critical thinking and knowledge of clinically appropriate treatment, evidence-based care, and clinical practice guidelines for Behavioral Health and/or medical conditions. Responsibilities include assessing treatment plan appropriateness, applying evidence-based standards, coordinating and monitoring healthcare services/benefits, providing triage and crisis support, gathering clinical information to render coverage determinations, and coordinating with providers to facilitate optimal care. The consultant will also identify members at risk for poor outcomes, facilitate referral opportunities, promote quality and effectiveness of healthcare services, and consult with internal and external constituents.

Skills

Clinical Skills
Utilization Management
Benefit Management
Critical Thinking
Behavioral Health
Medical Conditions
Treatment Planning
Evidence-Based Care
Practice Guidelines
Triage
Crisis Support
Discharge Planning
LCSW
LCPC
RN

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters
1963Year Founded
DEBTCompany Stage
Healthcare, Consumer GoodsIndustries
10,001+Employees

Benefits

Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Disability Insurance
401(k) Retirement Plan
Company Equity
Wellness Program
Professional Development Budget
Paid Vacation
Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.
The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.
The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.
The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.
CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.
Increased consumer interest in wellness boosts demand for CVS's health-related products.
The trend towards value-based care aligns with CVS's integrated healthcare approach.

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