Utilization Management Clinical Consultant

This is a fully remote position, open to applicants in Louisiana.

📋 Description

• Oversee, document, and communicate all elements of the utilization/benefit management program.

• Utilize critical thinking, clinically appropriate treatment knowledge, evidence-based care, and clinical practice guidelines for Behavioral Health and/or medical conditions.

• Evaluate the suitability of treatment plans across various levels of care using clinical experience, evidence-based standards, and practice guidelines.

• Coordinate, monitor, and assess options to ensure appropriate healthcare services and benefits for members.

• Provide triage and crisis support as needed.

• Collect clinical information and apply clinical criteria, guidelines, policies, procedures, and clinical judgment to make coverage determinations and recommendations throughout the continuum of care.

• Facilitate effective discharge planning processes.

• Collaborate with providers and other stakeholders to ensure optimal care and treatment.

• Identify members at risk for unfavorable outcomes and facilitate referrals to relevant products, services, and programs.

• Recognize opportunities to enhance the quality and effectiveness of healthcare services and benefit utilization.

• Consult with and lend expertise to both internal and external stakeholders in the coordination and administration of utilization/benefit management.

⛳️ Requirements

• Licensed independent Behavioral Health clinician (e.g., LCSW, LCPC, LMFT, LPCC, LPAT, LPC) in the state of Louisiana, or Registered Nurse (RN) with an unrestricted compact state license and psychiatric specialty experience.

• A minimum of 3 years of clinical practice experience, such as in a psychiatric hospital, residential, or behavioral health treatment setting.

• At least 1 year of experience with Electronic Medical Record documentation.

• Availability to work Monday through Friday, from 8:00 AM to 5:00 PM Central Standard Time (CST), with the flexibility to adapt to business needs, including occasional rotating weekend and holiday shifts.

• Master’s Level Education leading to independent Behavioral Health licensure, or RN with unrestricted state license and psychiatric specialty experience.

• Experience in a behavioral health inpatient environment is preferred.

• Ability to multitask, prioritize, and thrive in a fast-paced and dynamic setting.

• Proficiency in computer skills, including navigating multiple systems and keyboarding effectively.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources to support physical, emotional, and financial well-being.

• CVS Health bonus, commission, or short-term incentive program available in addition to the base pay range, if eligible.