Behavioral Health Utilization Clinician

CVS Health; Mississippi; Hybrid; USD 36,000 - 103,000; Full time

Job summary

CVS Health is seeking a clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program. The role focuses on applying clinical judgment and medical necessity criteria to determine appropriate services for child and adolescent members.

Responsibilities include consulting with internal and external stakeholders, coordinating care, and identifying patients who may benefit from care management, with occasional regional travel up to 10% in the United

Qualifications

• 2+ years of behavioral health experience.
• Active AZ clinical/counseling license (RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW).
• Willingness to work 8am-5pm (Arizona Time), with occasional weekends/holidays as needed.
• Willingness to travel up to 10% of the time within the United States.

Responsibilities

• Coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Apply medical necessity criteria and clinical judgment for utilization of services.
• Consult with internal and external constituents in utilization/benefit management.
• Identify members who may benefit from care management and facilitate referrals.
• Collaborate with providers to coordinate and facilitate optimal care.

Skills

Behavioral health experience

Communication skills

Organization & time management

Education

Masters-level clinician or RN licensed in AZ

Job description

CVS Health is seeking a clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program. The role focuses on applying clinical judgment and medical necessity criteria to determine appropriate services for child and adolescent members.

Responsibilities include consulting with internal and external stakeholders, coordinating care, and identifying patients who may benefit from care management, with occasional regional travel up to 10% in the United