[Remote] Utilization Management Clinical Consultant (Monday - Friday)

Note: The job is a remote job and is open to candidates in USA. CVS Health is the nation’s leading health solutions company, dedicated to transforming health care for millions of Americans. The Utilization Management Clinical Consultant will utilize clinical skills to manage utilization and benefit programs, ensuring appropriate healthcare services for members.

Responsibilities

• Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program
• Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus
• Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guidelines to treatment where appropriate
• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
• Provides triage and crisis support
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning
• Coordinates with providers and other parties to facilitate optimal care/treatment
• Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

Skills

• Licensed independent Behavioral Health clinician (i.e. LCSW, LCPC, LMFT, LPCC, LPAT, LPC) in state of Louisiana or a Registered Nurse (RN) with unrestricted compact state license with psychiatric specialty experience
• 3 years clinical practice experience, e.g., psychiatric hospital, residential or behavioral health treatment setting
• 1 year Electronic Medical Record documentation experience
• Must be able to work Monday through Friday, 8:00 AM to 5:00 PM Central Standard Time (CST) zone with flexibility to work outside of the standard schedule based on business needs, including occasional rotating weekend and holiday schedules
• Master's Level of Education resulting in independent Behavioral Health licensure (LCSW, LCPC, LMFT, LPCC, LPAT, LPC) or a Registered Nurse (RN) with unrestricted state license with psychiatric specialty experience
• Strongly prefer someone who resides in Louisiana
• Managed care/utilization review experience preferred
• LAC (Licensed Addiction Counselor) preferred

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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