Utilization Management Clinical Consultant – Tuesday - Saturday

Job not on LinkedIn

🔥 9 minutes ago

🏈 Alabama, Alaska, +45 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🏛️ District of Columbia – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $26 - $56 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

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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 and benefit management program • Apply critical thinking, evidence-based care, clinical practice guidelines, policies, procedures, and clinical judgment to Behavioral Health and/or medical conditions • Assess treatment-plan appropriateness across levels of care • Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits • Provide triage and crisis support • Gather clinical information and render coverage determinations or 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 integrated products, services, and programs • Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization • Consult with internal and external constituents on utilization and benefit management coordination and administration

🎯 Requirements

• LCSW, LCPC, or RN with experience in a psychiatric setting required • Independent Behavioral Health clinician license or unrestricted Registered Nurse (RN) license within Louisiana or compacted, with 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 • Reliable high-speed internet access • Flexibility to work Tuesday–Saturday, 8am–5pm CST, outside standard hours as needed, including occasional rotating weekend and holiday schedules • Master's-level education resulting in independent Behavioral Health licensure, or bachelor's-level education resulting in an RN with an unrestricted state license and psychiatric specialty experience • Computer proficiency, including navigating multiple systems and keyboarding • Managed care/utilization review experience preferred • Experience in a behavioral health inpatient setting preferred

🏖️ 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 eligibility