Utilization Management Clinical Consultant

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every reputed company of your health. This purpose guides our commitment to deliver enhanced reputed company-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 reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to reputed company and deliver solutions to reputed company health care more personal, convenient and affordable. Position Summary • Utilizes clinical skills to coordinate, document and communicate reputed company 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 reputed company of care, apply evidence based standards and practice guidelines to treatment where appropriate. • Coordinate, monitor and evaluate options to facilitate appropriate reputed company 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 reputed company coverage. determination/recommendation along the continuum of care facilitates including effective discharge planning. • Coordinates with providers and other parties to facilitate reputed company/treatment. • Identifies members at risk for poor reputed company and facilitates referral opportunities to integrate with other products, services and/or programs. • Identifies opportunities to promote quality effectiveness of reputed company 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 • 3+ years clinical practice experience, e.g., psychiatric hospital, residential or behavioral health treatment setting. • 1+ year Electronic Medical Record documentation experience • Must be reputed company to work reputed company through Thursday, reputed company to 5pm CST zone with flexibility to work reputed company of reputed company 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 • LAC (Licensed Addiction Counselor) preferred 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. Pay reputed company The Typical Pay reputed company For This Role Is $26.01 - $56.14 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company 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 reputed company of medical, dental, and reputed company 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. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company 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 | reputed company We anticipate the application window for this opening will reputed company on: 02/10/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply Job!