Behavioral Health Utilization Management Clinical Consultant

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose‑driven colleagues — caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate.

And we do it all with heart, each and every day.

• 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, 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.

• 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 Tuesday through Saturday, 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.

• Preference for someone who lives in Louisiana, not required.
• 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.
• LAC (Licensed Addiction Counselor) preferred.

• 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.

Anticipated Weekly

Hours:

40

Time Type: Full time

Pay Range: $26.01 - $56.14

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 short‑term incentive program in addition to the base pay range listed above.

We take pride in our comprehensive and competitive mix of pay and benefits — investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Afforda…