Utilization Management Clinical Consultant – Tuesday - Saturday

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

📋 Description

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

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

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

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

• Provide triage and crisis intervention support.

• Collect clinical data and make coverage determinations or recommendations throughout the continuum of care.

• Support effective discharge planning.

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

• Identify members at risk for adverse outcomes and facilitate their referrals to integrated products, services, and programs.

• Spot opportunities to enhance the quality and effectiveness of healthcare services and benefit usage.

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

⛳️ Requirements

• LCSW, LCPC, or RN with experience in a psychiatric environment is mandatory.

• Must possess an independent Behavioral Health clinician license or an unrestricted Registered Nurse (RN) license in Louisiana or a compact state, along with psychiatric specialty experience.

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

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

• Access to reliable high-speed internet.

• Availability to work from Tuesday to Saturday, 8 am to 5 pm CST, with flexibility to work outside standard hours as necessary, including occasional rotating weekend and holiday schedules.

• Master’s-level education leading to independent Behavioral Health licensure, or a bachelor’s-level degree resulting in an unrestricted RN license with psychiatric specialty experience.

• Proficient in computer skills, including navigating various systems and typing.

• Experience in managed care/utilization review is preferred.

• Prior experience in a behavioral health inpatient setting is 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.

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