Description

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

MUST HAVE LICENSURE IN KENTUCKY - SEE REQUIRED QUALIFICATIONS FOR LICENSING DETAILS

This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna Better Health of Kentucky. The schedule is Monday-Friday, 8am-5pm with flexibility to work outside of the standard schedule based on business needs.

• Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
• 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.
• Provides triage and crisis support.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage. determination/recommendation along the continuum of care facilitates including effective discharge planning.
• 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.

Required Qualifications

• Kentucky Licensed Independent Behavioral Health Clinician ( LPCC, LCSW, LMFT, LPAT ) - OR - Active unrestricted Compact Registered Nurse (RN) license with psychiatric specialty or behavioral health experience.
• 3+ years clinical practice experience in a behavioral health setting e.g., psychiatric hospital, residential, or behavioral health treatment setting
• 1+ year Electronic Medical Record documentation experience
• Dedicated High Speed Internet Access
• Schedule is Monday-Friday, 8:00am-5:00pm EST with flexibility to work outside of the standard schedule based on business needs

Preferred Qualifications

• Residency in Kentucky or bordering counties
• Experience working with Substance Use Disorder diagnoses
• Managed care/utilization review experience
• Medicaid experience
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
• Experience with MS office applications including Teams, Outlook, Word, and Excel
• Remote work experience
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment

Education

• Master's Level of Education resulting in independent Behavioral Health licensure (LCSW, LPCC, LMFT, LPAT, LP, LBA) or an Associate's degree in Nursing with a KY or compact state Registered Nurse (RN) License with psychiatric specialty or behavioral health experience.

Anticipated Weekly Hours
40

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.

We anticipate the application window for this opening will close on: 05/07/2026

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