Utilization Management Clinical Consultant

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.

Are you a licensed Behavioral Health professional or Psychiatric RN looking to make a meaningful impact on members' mental health outcomes? Join our Utilization Management team and play a critical role in ensuring members receive appropriate, evidence-based behavioral health services while supporting quality care and effective treatment planning.

• Review behavioral health services and treatment plans to determine medical necessity and appropriateness of care

• Apply evidence-based guidelines and clinical best practices across multiple levels of care

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

• Provide triage support and crisis intervention as needed

• Facilitate effective discharge planning and transitions of care

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

• Promote quality, cost-effective healthcare utilization and positive member outcomes

• Collaborate with internal and external stakeholders to support comprehensive care management

• Active, unrestricted independent Behavioral Health license in Louisiana (
  LCSW, LCPC, LMFT, LPCC, LPAT, LPC )
  or

• Active, unrestricted Compact RN license with psychiatric specialty experience

• 3+ years of behavioral health clinical practice experience, such as:

  • Psychiatric hospital
  • Residential treatment
  • Behavioral health treatment settings

• 1+ year of Electronic Medical Record (EMR) documentation experience

• Ability to work Sunday
  - Thursday, 8:00 AM - 5:00 PM Central Standard Time (CST), with flexibility for occasional weekends and holidays

• Louisiana residency strongly preferred

• Managed Care, Utilization Review, or Utilization Management experience

• Behavioral health inpatient experience

• Licensed Addiction Counselor (LAC) certification

• Strong multitasking, prioritization, and organizational skills

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

• Master's degree required for independently licensed Behavioral Health clinicians

• Registered Nurse with psychiatric specialty experience and unrestricted nursing license also considered (Bachelors Degree in Nursing)

• Opportunity to improve behavioral health outcomes for members across the continuum of care
• Collaborative environment with providers, care managers, and clinical experts
• Apply your clinical expertise in a meaningful, non-traditional care setting
• Influence quality, access, and effectiveness of behavioral health services
• Remote flexibility with a supportive team culture

If you're passionate about behavioral health, utilization management, and helping members access the right level of care at the right time, we'd love to hear from you.

40

Full time

The typical pay range for this role is:

$26.01 - $56.14

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…