Behavioral Health Utilization Clinician | UM Consultant

CVS Health; Phoenix (AZ); On-site; USD 36,000 - 103,000; Full time

Benefits offered by this job

Bonus eligibility

Job summary

CVS Health in Phoenix, AZ is seeking a licensed behavioral health professional to coordinate utilization/benefit management for child and adolescent members. The role applies clinical judgment to determine medical necessity and communicates with providers to optimize care within the benefits program.

The position is full-time (40 hours weekly), Monday–Friday 8am–5pm Arizona time, with occasional weekend and holiday shifts and up to 10% travel within the United States.

Qualifications

• 2+ years of behavioral health experience.
• Arizona clinical license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW).
• Hours Mon-Fri 8am-5pm MT; weekends/holidays optional.
• Travel up to 10% within the United States.

Responsibilities

• Coordinate, document, and communicate utilization/benefit management.
• Apply clinical criteria for pediatric utilization and medical necessity.
• Consult with internal/external constituents on utilization functions.
• Gather clinical information to render coverage determinations.
• Collaborate to evaluate and facilitate healthcare services/benefits for members.
• Coordinate with providers to facilitate optimal care.
• Identify members who may benefit from care management and referrals.
• Promote quality and effectiveness of services.
• Sedentary work with periods of sitting, talking, listening.

Skills

BH experience

Arizona license

M-F 8-5 MT

Travel 10%

Education

Master's level clinician / RN

Job description

CVS Health in Phoenix, AZ is seeking a licensed behavioral health professional to coordinate utilization/benefit management for child and adolescent members. The role applies clinical judgment to determine medical necessity and communicates with providers to optimize care within the benefits program.

The position is full-time (40 hours weekly), Monday–Friday 8am–5pm Arizona time, with occasional weekend and holiday shifts and up to 10% travel within the United States.