Utilization Management Clinical Consultant (Tuesday - Saturday)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Schedule is Tuesday-Saturday with flexibility to work outside of the standard schedule based on business needs 

LCSW, LCPC, RN with experience in psychiatricsettingrequired. 

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.  

Applies critical thinking and is knowledgeable in clinicallyappropriate 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, applyevidence based standards and practice guidelines to treatment whereappropriate. 
Coordinate,monitor and evaluate options tofacilitateappropriate 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 carefacilitates including effective discharge planning. 
Coordinates with providers and other parties tofacilitateoptimal care/treatment. 
Identifies members at risk for poor outcomes andfacilitates referral opportunities to integrate with other products,services and/or programs. 
Identifies opportunities to promote quality effectiveness of healthcare services and benefitutilization. 
Consults and lendsexpertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. 

RequiredQualifications : 

• Independent Behavioral Health clinician License or an Unrestricted Registered Nurse (RN) License either within the state of LA or Compacted 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 have reliable High Speed internet access 

• Work Schedule is Tuesday – Saturday, 8am – 5pm CST. Must have flexibility to work outside of the standard schedule based on business needs, including occasional rotating weekend and holiday schedules.   

 PreferredQualifications: 

• Prefers someone who resides in Louisiana

• Managed care/utilization review experience preferred 
  Experience in a behavioral health inpatient setting 

• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment 

• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding 

Education : 

• Master's Level of Education resulting in independent Behavioral Health licensure (LCSW, LPCC, LMFT, LPAT, LP) or a Bachelor’s Level of Education resulting in a Registered Nurse (RN) with an unrestricted state license with psychiatric specialty experience

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and onBenefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.