Utilization Management Clinical Consultant (Tuesday-Saturday) - Work From Home Louisiana

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As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

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

• 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 Tuesday-Saturday , 8am to 5pm CST zone with flexibility to work outside of the standard schedule based on business needs, including occasional rotating weekend and holiday schedules.  ​

Preferred Qualifications: 

• 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 licensu