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 Monday
  - Friday, 8:00 AM to 5:00 PM Central Standard Time (CST)/
  Tuesday
  - Saturday, 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 (Bachelor's 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

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