Utilization Management Clinical Consultant – Tuesday, Saturday

This is a fully remote position, open to applicants in Alabama, +46 more states.

📋 Description

• Evaluate behavioral health services and treatment plans to assess medical necessity and care appropriateness.

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

• Coordinate and communicate utilization management decisions with providers and care teams effectively.

• Offer triage support and crisis intervention as required.

• Facilitate efficient discharge planning and transitions of care.

• Identify members at risk for adverse outcomes and coordinate referrals to additional programs and services.

• Encourage quality, cost-effective healthcare utilization and positive 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 with Electronic Medical Record (EMR) documentation.

• Availability to work Monday–Friday or Tuesday–Saturday from 8:00 AM to 5:00 PM Central Standard Time, 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).

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

• Preferred experience in behavioral health inpatient settings.

• Licensed Addiction Counselor (LAC) certification is preferred.

• Strong skills in multitasking, prioritization, and organization are essential.

• Proficiency in navigating multiple systems and applications in a fast-paced environment is required.

• Residency in Louisiana is strongly preferred.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Remote flexibility with a supportive team culture.

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.