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Utilization Management Clinical Consultant – Sunday, Thursday
CVS Health. Review behavioral health services and treatment plans to determine medical necessity and appropriateness of care .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Behavioral Health services, including medical necessity reviews, crisis intervention, and care coordination. Proficient in utilizing evidence-based guidelines and managing comprehensive care for positive member outcomes.
Highest-signal resume keywords
Active Behavioral Health License3+ Years Clinical Practice ExperienceElectronic Medical Record DocumentationUtilization Management ExperienceCrisis Intervention Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Behavioral Health Services ReviewEvidence-Based Guidelines ApplicationCare CoordinationDischarge PlanningCrisis InterventionUtilization ReviewBehavioral Health Inpatient ExperienceMultitaskingPrioritizationOrganizational Skills
Soft Skills
Communication SkillsCollaborationFlexibility
Tools & Technologies
Electronic Medical Record (EMR)
Certifications & Qualifications
Licensed Addiction Counselor (LAC)Active Unrestricted RN License
Industry Keywords
Managed CareUtilization ManagementBehavioral HealthCrisis InterventionCare Management
About the role
Key responsibilities & impact- Review behavioral health services and treatment plans to determine medical necessity and appropriateness of care
- Apply evidence-based guidelines and clinical best practices across multiple levels of care
- Coordinate and communicate utilization management decisions with providers and care teams
- Provide triage support and crisis intervention as needed
- Facilitate effective discharge planning and transitions of care
- Identify members at risk for poor outcomes and coordinate referrals to additional programs and services
- Promote quality, cost-effective healthcare utilization and positive member outcomes
- Collaborate with internal and external stakeholders to support comprehensive care management
Requirements
What you’ll need- Active, unrestricted independent Behavioral Health license in Louisiana (LCSW, LCPC, LMFT, LPCC, LPAT, LPC), or active, unrestricted Compact RN license with psychiatric specialty experience
- 3+ years of behavioral health clinical practice experience
- At least 1 year of Electronic Medical Record (EMR) documentation experience
- Ability to work Sunday–Thursday, 8:00 AM–5:00 PM Central Standard Time, with flexibility for occasional weekends and holidays
- Master's degree required for independently licensed Behavioral Health clinicians
- Registered Nurse with psychiatric specialty experience and unrestricted nursing license also considered (Bachelor’s Degree in Nursing)
- Louisiana residency strongly preferred
- Managed Care, Utilization Review, or Utilization Management experience preferred
- Behavioral health inpatient experience preferred
- Licensed Addiction Counselor (LAC) certification preferred
- Strong multitasking, prioritization, and organizational skills
- Proficiency navigating multiple systems and applications in a fast-paced environment
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program in addition to the base pay range
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- Remote flexibility with a supportive team culture