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CVS Health · 1 day ago

Behavioral Health Utilization Management Clinical Consultant (Tuesday - Saturday)

Baton Rouge, LA

Full-time

Onsite

Mid Level

$26.01/hr - $56.14/hr

3+ years exp

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care for millions of Americans. The Behavioral Health Utilization Management Clinical Consultant utilizes clinical skills to coordinate and communicate aspects of the utilization/benefit management program, ensuring appropriate healthcare services for members while collaborating with providers and assessing treatment plans.

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Responsibilities

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 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

Qualification

Licensed Behavioral Health clinicianClinical practice experienceElectronic Medical RecordManaged care experienceMultitaskingComputer proficiencyCrisis supportCollaboration skills

Required

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

Preferred

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

Benefits

Affordable medical plan options

401(k) plan (including matching company contributions)

Employee stock purchase plan

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching

Paid time off

Flexible work schedules

Family leave

Dependent care resources

Colleague assistance programs

Tuition assistance

Retiree medical access