Utilization Management Clinical Consultant

4062 Aetna Resources, LLC; Louisiana; Hybride; USD 36 000 - 77 000; Plein temps

Avantages offerts par ce poste

Comprehensive benefits

Bonus eligibility

Paid time off

Retirement savings options

Résumé du poste

CVS Health is seeking a full-time Behavioral Health Utilization Clinician in Louisiana. You will coordinate and document utilization/benefit management, apply evidence-based guidelines, and collaborate with providers to ensure appropriate care.

The role requires a licensed behavioral health clinician or an RN with psychiatric specialty, with 3 years clinical practice and 1 year EMR experience. 40-hour work week, CST schedule, plus potential flexibility.

Qualifications

• Licensed independent Behavioral Health clinician in Louisiana or RN with psychiatric specialty.
• 3 years clinical practice in behavioral health settings.
• 1 year EMR documentation experience.

Responsabilités

• Coordinate, document and communicate utilization/benefit management activities.
• Assess treatment plan appropriateness across levels of care using guidelines.
• Coordinate with providers to facilitate optimal care and services.
• Provide triage and crisis support.
• Apply clinical criteria to render coverage recommendations.
• Identify at-risk members and promote referrals to programs.

Connaissances

Clinical coordination

Critical thinking

Multi-tasking

Collaboration

Formation

Master's level licensure

Outils

Electronic Medical Records (EMR)

Description du poste

Position Summary

• 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 judgement to render coverage. determination/recommendation along the continuum of care facilitates 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.

Required Qualifications

• 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 Monday through Friday, 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.

Preferred Qualifications

• Strongly prefer 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.
• LAC (Licensed Addiction Counselor) preferred.

Education

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

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.

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.

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.

The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

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

We anticipate the application window for this opening will close on: 11/30/2026

Our Work Experience

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.