Behavioral Health Utilization Consultant

CVS Health Corporation; Phoenix (AZ); On-site; USD 3,583,000 - 10,302,000; Full time

Job summary

CVS Health Corporation in Phoenix, AZ is seeking a qualified clinician to coordinate and document utilization/benefit management. The role emphasizes applying medical necessity criteria for child and adolescent members and communicating with providers to ensure appropriate care.

You will gather clinical information, render coverage determinations and discharge planning along the continuum of care, including urgent interventions when needed.

Qualifications

• 2+ years of clinical, behavioral health setting experience in utilization management.
• Active and in good standing Arizona clinical license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW).
• Ability to work Monday–Friday 8am-5pm AZ time; occasional weekends/holidays.
• Willingness to travel up to 10% within Phoenix, AZ.

Responsibilities

• Coordinate, document, and communicate all aspects of utilization/benefit management.
• Apply clinical judgment and medical necessity criteria for appropriate service utilization.
• Consult with internal and external stakeholders to support utilization/benefit management.
• Gather clinical information and render coverage determinations and discharge planning as needed.
• Collaborate with providers and other parties to facilitate optimal patient care.
• Identify members who may benefit from care management and facilitate referrals.

Skills

Utilization management experience

Clinical licensure (AZ RN/LPC/LAC/LMFT

Microsoft Word

Microsoft Excel

Education

Master’s-level clinician and/or RN, licensed in Arizona

Tools

Microsoft Office Suite

Job description

CVS Health Corporation in Phoenix, AZ is seeking a qualified clinician to coordinate and document utilization/benefit management. The role emphasizes applying medical necessity criteria for child and adolescent members and communicating with providers to ensure appropriate care.

You will gather clinical information, render coverage determinations and discharge planning along the continuum of care, including urgent interventions when needed.