Utilization Management Clinical Consultant

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

📋 Description

• Oversee, document, and communicate every aspect of the utilization and benefit management program.

• Utilize critical thinking, evidence-based care, and clinical practice guidelines pertaining to Behavioral Health and/or medical conditions.

• Evaluate the appropriateness of treatment plans across various levels of care.

• Implement evidence-based standards and practice guidelines in treatment.

• Coordinate, monitor, and assess options to ensure suitable healthcare services and benefits.

• Provide triage and crisis intervention support.

• Collect clinical information and apply clinical criteria, policies, procedures, and judgment to make coverage determinations and recommendations.

• Facilitate efficient discharge planning.

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

• Identify members at risk of poor outcomes and facilitate necessary referral opportunities.

• Enhance the quality and effectiveness of healthcare services and benefit utilization.

• Consult with both internal and external stakeholders regarding the coordination and administration of utilization and benefit management.

⛳️ Requirements

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

• A minimum of 3 years of clinical practice experience in settings such as psychiatric hospitals, residential, or behavioral health treatment environments.

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

• Availability to work Monday through Friday, from 8:00 AM to 5:00 PM Central Standard Time, with flexibility to accommodate business needs, including occasional rotating weekends and holidays.

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

• Preferred experience in managed care/utilization review.

• Experience in a behavioral health inpatient setting.

• Capability to multitask, prioritize, and adapt to a fast-paced, changing environment.

• Proficient computer skills, including the ability to navigate multiple systems and keyboard effectively.

• Licensed Addiction Counselor (LAC) preferred.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• 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.