Utilization Management Clinical Consultant

Job not on LinkedIn

🔥 34 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $26 - $56 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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, 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 • Provide triage and crisis support • Gather clinical information and apply clinical criteria, policies, procedures, and judgment to render coverage determinations/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 referral opportunities • Promote quality and effectiveness of healthcare services and benefit utilization • Consult with internal and external constituents on utilization/benefit management coordination and administration

🎯 Requirements

• Licensed independent Behavioral Health clinician (LCSW, LCPC, LMFT, LPCC, LPAT, LPC) in Louisiana, or Registered Nurse (RN) with unrestricted compact state license and psychiatric specialty experience • 3 years of clinical practice experience, such as psychiatric hospital, residential, or behavioral health treatment setting • 1 year of Electronic Medical Record documentation experience • Ability to work Monday through Friday, 8:00 AM to 5:00 PM Central Standard Time, with flexibility outside standard schedules based on business needs, including occasional rotating weekends and holidays • Master's level education resulting in independent Behavioral Health licensure, or RN with unrestricted state license and psychiatric specialty experience • Managed care/utilization review experience preferred • Behavioral health inpatient setting experience • Ability to multitask, prioritize, and adapt to a fast-paced changing environment • Proficiency with computer skills, including navigating multiple systems and keyboarding • LAC (Licensed Addiction Counselor) preferred

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • 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