CVS Health
Utilization Management Clinical Consultant
CVS Health, Baton Rouge, Louisiana, us, 70873
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position SummaryUtilizes 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.
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, and addiction Counselor licensure
Required to obtain LAC certification within 6 months of hire date
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, 8am to 5pm CST zone with flexibility to work outside of the standard schedule based on business needs
, including occasional rotating weekend and holiday schedules.
Preferred
Qualifications: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
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, certification, or experience.
Licensed Addiction Counselor (LAC)
preferred but not required
Pay RangeThe 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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company
policies.
For more detailed information on available benefits, please visit
Benefits | CVS HealthWe anticipate the application window for this opening will close on:
09/27/2024 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr
Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position SummaryUtilizes 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.
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, and addiction Counselor licensure
Required to obtain LAC certification within 6 months of hire date
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, 8am to 5pm CST zone with flexibility to work outside of the standard schedule based on business needs
, including occasional rotating weekend and holiday schedules.
Preferred
Qualifications: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
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, certification, or experience.
Licensed Addiction Counselor (LAC)
preferred but not required
Pay RangeThe 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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company
policies.
For more detailed information on available benefits, please visit
Benefits | CVS HealthWe anticipate the application window for this opening will close on:
09/27/2024 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr