Utilization Management Clinical Consultant

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

📋 Description

• Assess behavioral health services and treatment plans to establish medical necessity and the suitability of care.

• Implement evidence-based guidelines and clinical best practices across various levels of care.

• Coordinate and relay utilization management decisions with providers and care teams.

• Offer triage support and crisis intervention as required.

• Ensure effective discharge planning and transitions of care.

• Identify members at risk of unfavorable outcomes and coordinate referrals to supplementary programs and services.

• Advocate for quality, cost-effective healthcare utilization and favorable member outcomes.

• Collaborate with both internal and external stakeholders to enhance comprehensive care management.

⛳️ Requirements

• An active, unrestricted independent Behavioral Health license in Louisiana (LCSW, LCPC, LMFT, LPCC, LPAT, LPC), or an active, unrestricted Compact RN license with psychiatric specialty experience.

• A minimum of 3 years of clinical practice experience in behavioral health.

• At least 1 year of experience in Electronic Medical Record (EMR) documentation.

• Availability 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.

• A Master's degree is required for independently licensed Behavioral Health clinicians.

• Registered Nurses with psychiatric specialty experience and an unrestricted nursing license will also be considered (Bachelor’s Degree in Nursing).

• Residency in Louisiana is strongly preferred.

• Experience in Managed Care, Utilization Review, or Utilization Management is preferred.

• Behavioral health inpatient experience is preferred.

• Licensed Addiction Counselor (LAC) certification is preferred.

• Strong multitasking, prioritization, and organizational abilities.

• Proficient in 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.

• Additional resources supporting physical, emotional, and financial well-being, based on eligibility.

• Remote flexibility within a supportive team culture.