CVS Health
Remote/Telecommute
Utilization Management Clinical Consultant Behavioral Health
Posted over 1 month ago
Job Description
Job Description
Schedule is Monday-Friday, with flexibility to work outside of standard schedule based on business needs.
The Behavioral Health Utilization Management Clinical Consultant utilizes clinical skills to coordinate, document and communicate the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services. Fundamental Components include:
* Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
* Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions
* Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
* Identifies members who may benefit from care management programs and facilitates referral
* Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
Exempt
Required Qualifications
Must be a Licensed Mental Health Professional with one of the following active & unrestricted Louisiana state licenses:
(a) Medical psychologist.
(b) Licensed psychologist.
(c) Licensed clinical social worker (LCSW).
(d) Licensed professional counselor (LPC).
(e) Licensed marriage and family therapist (LMFT).
(f) Licensed addiction counselor (LAC).
(g) Licensed Advanced Practice Registered Nurse (APRN).
(h) Licensed rehabilitation counselor (LRC).
- 3 years of behavioral health clinical practice experience required
- Experience and knowledge in clinical guidelines, systems and tools such as MCG, LOCUS, CALOCUS, and ASAM
- Knowledge of provider networks and delivery
- Strong organizational skills with an attention to detail
- Ability to work independently and on a team
- Strong documentation skills and broad based clinical- knowledge
- Behavioral health and physical health integrated care experience
- Be self-motivated and confident making clinical decisions with the ability to influence and shape clinical outcomes
- Proficiency with computer skills which includes navigating multiple systems
- Ability to multitask, prioritize and effectively adapt to a fast-paced, changing environment
Preferred Qualifications
- Managed care/utilization review experience strongly preferred.
- Experience working in the Louisiana Medicaid Behavioral Health system strongly preferred.
Education
- Master's degree required
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
Schedule is Monday-Friday, with flexibility to work outside of standard schedule based on business needs.
The Behavioral Health Utilization Management Clinical Consultant utilizes clinical skills to coordinate, document and communicate the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services. Fundamental Components include:
* Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
* Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions
* Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
* Identifies members who may benefit from care management programs and facilitates referral
* Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
Exempt
Required Qualifications
Must be a Licensed Mental Health Professional with one of the following active & unrestricted Louisiana state licenses:
(a) Medical psychologist.
(b) Licensed psychologist.
(c) Licensed clinical social worker (LCSW).
(d) Licensed professional counselor (LPC).
(e) Licensed marriage and family therapist (LMFT).
(f) Licensed addiction counselor (LAC).
(g) Licensed Advanced Practice Registered Nurse (APRN).
(h) Licensed rehabilitation counselor (LRC).
- 3 years of behavioral health clinical practice experience required
- Experience and knowledge in clinical guidelines, systems and tools such as MCG, LOCUS, CALOCUS, and ASAM
- Knowledge of provider networks and delivery
- Strong organizational skills with an attention to detail
- Ability to work independently and on a team
- Strong documentation skills and broad based clinical- knowledge
- Behavioral health and physical health integrated care experience
- Be self-motivated and confident making clinical decisions with the ability to influence and shape clinical outcomes
- Proficiency with computer skills which includes navigating multiple systems
- Ability to multitask, prioritize and effectively adapt to a fast-paced, changing environment
Preferred Qualifications
- Managed care/utilization review experience strongly preferred.
- Experience working in the Louisiana Medicaid Behavioral Health system strongly preferred.
Education
- Master's degree required
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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