Behavioral Health Utilization Consultant

CVS Health; United States; Remote; USD 36,000 - 103,000; Full time

Job summary

CVS Health is seeking a qualified clinician to coordinate and document utilization/benefit management for behavioral health services. You will apply evidence-based criteria to determine medical necessity, collaborate with providers, and support care decisions for child and adolescent members.

The role involves travel up to 10% within the United States and requires Arizona licensure. The position is full-time with standard weekday hours and potential weekend/holiday coverage as needed.

Qualifications

• 2+ years of behavioral health experience.
• Arizona license required (RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW).
• Willingness to work Monday–Friday 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 clinical knowledge to assess treatment and medical necessity criteria for utilization of services for child and adolescent members.
• Consult with internal and external stakeholders on utilization/benefit management processes.
• Gather clinical information and apply medical necessity criteria to render coverage determinations.
• Collaborate with providers and other parties to facilitate optimal care and treatment.
• Identify members who may benefit from care management programs and facilitate referrals.

Skills

Behavioral health experience

Education

Masters-level clinician

RN license in Arizona

Job description

CVS Health is seeking a qualified clinician to coordinate and document utilization/benefit management for behavioral health services. You will apply evidence-based criteria to determine medical necessity, collaborate with providers, and support care decisions for child and adolescent members.

The role involves travel up to 10% within the United States and requires Arizona licensure. The position is full-time with standard weekday hours and potential weekend/holiday coverage as needed.