Utilization Management Clinical Consultant (Monday - Friday)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.

- Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.  

- Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guidelines to treatment where appropriate. 

- Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. 

- Provides triage and crisis support. 

- Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage. determination/recommendation along the continuum of care facilitates including effective discharge planning. 

- Coordinates with providers and other parties to facilitate optimal care/treatment. 

- Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs. 

- Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization. 

- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Required Qualifications

- Licensed independent Behavioral Health clinician (i.e. LCSW, LCPC, LMFT, LPCC, LPAT, LPC) in state of Louisiana or a Registered Nurse (RN) with unrestricted compact state license with 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.

- Must be able to work Monday through Friday, 8:00 AM to 5:00 PM Central Standard Time (CST) zone with flexibility to work outside of the standard schedule based on business needs, including occasional rotating weekend and holiday schedules.  ​

Preferred Qualifications

- Strongly prefer someone who resides in Louisiana.

- Managed care/utilization review experience preferred.

Experience in a behavioral health inpatient setting.

- Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.

- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.

- LAC (Licensed Addiction Counselor) preferred.

Education

- Master's Level of Education resulting in independent Behavioral Health licensure (LCSW, LCPC, LMFT, LPCC, LPAT, LPC) or a Registered Nurse (RN) with unrestricted state license with psychiatric specialty experience. 

Anticipated Weekly Hours

Time Type