Clinical Utilization & Care Coordination Consultant

CVS Health Corporation; Louisiana (MO); Hybrid; USD 36,000 - 77,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation is seeking an experienced Behavioral Health clinician to coordinate utilization and benefit management. The role involves applying evidence-based guidelines, triage support, and coordinating with providers to ensure optimal care for members.

Ideal candidates hold a licensed independent Behavioral Health credential or RN with psychiatric specialty, with 3 years of clinical practice and EMR experience. Typical hours are M–F, CST, with potential weekend/holiday scheduling.

Qualifications

• Licensed independent Behavioral Health clinician in Louisiana or RN with psychiatric specialty.
• 3 years clinical practice experience in psychiatric/h behavioral health settings.
• 1 year EMR documentation experience.
• Must be able to work Monday–Friday 8:00 AM–5:00 PM CST with flexibility for nonstandard hours including weekends/holidays.

Responsibilities

• Utilizes clinical skills to coordinate, document and communicate utilization/benefit management.
• Applies evidence-based care and guidelines for Behavioral Health and/or medical conditions.
• Assesses appropriateness of treatment plans and applies clinical criteria across care levels.
• Coordinates, monitors and evaluates options to facilitate appropriate healthcare services for members.
• Provides triage and crisis support.
• Gathers clinical information to render coverage determinations/recommendations.
• Coordinates with providers to enable optimal care and treatment.
• Identifies at-risk members and facilitates referrals to integrate with other programs.
• Explores opportunities to improve quality and effectiveness of healthcare services.
• Consults with internal/external stakeholders in utilization/benefit management.

Skills

Clinical coordination

Crisis management

Evidence-based practice

Communication

Education

Master's degree in Behavioral Health or RN with psychiatric specialty

Tools

Electronic Medical Records (EMR)

Job description

CVS Health Corporation is seeking an experienced Behavioral Health clinician to coordinate utilization and benefit management. The role involves applying evidence-based guidelines, triage support, and coordinating with providers to ensure optimal care for members.

Ideal candidates hold a licensed independent Behavioral Health credential or RN with psychiatric specialty, with 3 years of clinical practice and EMR experience. Typical hours are M–F, CST, with potential weekend/holiday scheduling.