Utilization Management Clinical Consultant

Job not on LinkedIn

🕒 September 8

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $26 - $56 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 43%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Open for 63 days.
• Jobs at this company usually fill in 21 days.
• Reposted 3 times.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 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 • Apply evidence-based standards and practice guidelines to treatment • 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 judgment to render coverage determinations or recommendations • 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 promote quality and effectiveness of healthcare services and benefit utilization • Consult with internal and external constituents regarding utilization/benefit management coordination and administration

🎯 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 Registered Nurse (RN) with unrestricted state license and psychiatric specialty experience • Proficiency with computer skills, including navigating multiple systems and keyboarding • Managed care/utilization review experience preferred • Experience in a behavioral health inpatient setting • Ability to multitask, prioritize and adapt to a fast-paced changing environment • LAC (Licensed Addiction Counselor) preferred

🏖️ Benefits

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

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