Utilization Management Clinical Consultant

Job not on LinkedIn

🔥 2 hours ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $26 - $56 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Coordinate, document and communicate all aspects of the utilization/benefit management program • Apply critical thinking, clinically appropriate treatment knowledge, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions • Assess appropriateness of treatment plans across levels of care using clinical experience, evidence-based standards and practice guidelines • Coordinate, monitor and evaluate options to facilitate appropriate healthcare services and benefits for members • Provide triage and crisis support • Gather clinical information and apply clinical criteria, guidelines, policies, procedures and clinical judgment to render coverage determinations/recommendations across the continuum of care • Facilitate effective discharge planning • Coordinate with providers and other parties to facilitate optimal care and treatment • Identify members at risk for poor outcomes and facilitate referrals to related products, services and programs • Identify opportunities to improve quality and effectiveness of healthcare services and benefit utilization • Consult with and provide expertise to internal and external constituents in coordinating and administering utilization/benefit management

🎯 Requirements

• Licensed independent Behavioral Health clinician (i.e. LCSW, LCPC, LMFT, LPCC, LPAT, LPC) in state of Louisiana, or Registered Nurse (RN) with unrestricted compact state license and psychiatric specialty experience • 3 years clinical practice experience, e.g., psychiatric hospital, residential or behavioral health treatment setting • 1 year Electronic Medical Record documentation experience • Ability to work Monday through Friday, 8:00 AM to 5:00 PM Central Standard Time (CST), with flexibility outside standard schedule based on business needs, including occasional rotating weekend and holiday schedules • Master's Level of Education resulting in independent Behavioral Health licensure, or RN with unrestricted state license and psychiatric specialty experience • Experience in a behavioral health inpatient setting • Ability to multitask, prioritize and adapt to a fast-paced changing environment • Proficiency with computer skills, including navigating multiple systems and keyboarding

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program in addition to base pay range, if eligible

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