RN Utilization Management
HumanaFull Time
Mid-level (3 to 4 years), Senior (5 to 8 years)
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.
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.
Comprehensive pharmacy and healthcare services
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.