[Remote] UM Clinical Consultant at CVS Health

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.