Utilization Management Clinical Consultant (BH) (Tuesday - Saturday)

CVS Health•Work At Home-Louisiana, LA

6d•$26 - $56•Remote

About The Position

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. In this role you will be utilizing clinical experience and skills in a collaborative process to assess appropriate treatment plans across levels of care. Applying evidence-based standards and practice guidelines to treatment where appropriate. Coordinating, monitoring, and evaluating options to facilitate appropriate healthcare services/benefits for members. Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services, and/or programs. Providing triage and crisis support. Gathers clinical information and applying 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. You will also be coordinating with providers and other parties to facilitate optimal care/treatment. 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.

Requirements

Independent Behavioral Health clinician License either within the state of LA or Compact 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.

Nice To Haves

Preference to candidates who reside 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.
High level of technical skills

Responsibilities

Utilizing clinical experience and skills in a collaborative process to assess appropriate treatment plans across levels of care.
Applying evidence-based standards and practice guidelines to treatment where appropriate.
Coordinating, monitoring, and evaluating options to facilitate appropriate healthcare services/benefits for members.
Identifying members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services, and/or programs.
Providing triage and crisis support.
Gathering clinical information and applying 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.
Coordinating with providers and other parties to facilitate optimal care/treatment.
Identifying opportunities to promote quality effectiveness of healthcare services and benefit utilization.
Consulting and lending expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.