UM Clinical Consultant

Job DescriptionSchedule is 5 day work week including one weekend day (Sunday-Thursday) with flexibility to work outside of standard schedule based on business needs No travel is required. 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 utilizationExemptRequired QualificationsMust 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- 1+ years of experience and knowledge in clinical guidelines, systems and tools such as MCG, LOCUS, CALOCUS, and ASAM- 1+ years of experience with provider networks and delivery- 1+ years Behavioral health and physical health integrated care experienceCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications- Managed care/utilization review experience strongly preferred. - Experience working in the Louisiana Medicaid Behavioral Health system strongly preferred.-Licensed addiction counselor (LAC) and/or substance use disorder treatment experience preferredEducationMaster's degree requiredBusiness OverviewBring your heart to CVS HealthEvery 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-15