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

• Review behavioral health services and treatment plans to determine medical necessity and appropriateness of care • Apply evidence-based guidelines and clinical best practices across multiple levels of care • Coordinate and communicate utilization management decisions with providers and care teams • Provide triage support and crisis intervention as needed • Facilitate effective discharge planning and transitions of care • Identify members at risk for poor outcomes and coordinate referrals to additional programs and services • Promote quality, cost-effective healthcare utilization and positive member outcomes • Collaborate with internal and external stakeholders to support comprehensive care management

🎯 Requirements

• Active, unrestricted independent Behavioral Health license in Louisiana (LCSW, LCPC, LMFT, LPCC, LPAT, LPC), or active, unrestricted Compact RN license with psychiatric specialty experience • 3+ years of behavioral health clinical practice experience • 1+ year of Electronic Medical Record (EMR) documentation experience • Ability to work Monday–Friday, 8:00 AM–5:00 PM CST or Tuesday–Saturday, 8:00 AM–5:00 PM CST, with flexibility for occasional weekends and holidays • Master's degree required for independently licensed Behavioral Health clinicians • Registered Nurse with psychiatric specialty experience and unrestricted nursing license also considered (Bachelor’s Degree in Nursing) • Louisiana residency strongly preferred • Managed Care, Utilization Review, or Utilization Management experience preferred • Behavioral health inpatient experience preferred • Licensed Addiction Counselor (LAC) certification preferred • Strong multitasking, prioritization, and organizational skills • Proficiency navigating multiple systems and applications in a fast-paced environment

🏖️ 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 • Remote flexibility with a supportive team culture