Behavioral Health Utilization Consultant

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

Benefits offered by this job

Comprehensive benefits package

Bonus eligibility

Job summary

CVS Health is seeking a qualified clinician to coordinate and document utilization/benefit management activities for child and adolescent members. You will apply evidence-based criteria and medical necessity guidelines to render coverage decisions and referrals as part of a collaborative care team.

The role requires an active AZ clinical/counseling license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW) and 2+ years of behavioral health experience, with travel up to 10% within the United States.

Qualifications

• 2+ years of behavioral health experience.
• Active and good standing Arizona clinical and/or counseling license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW).
• Willingness to work Monday-Friday 8am-5pm (Arizona Time) and occasional weekends/holidays.
• 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 judgment to determine medical necessity and provide coverage determinations/recommendations.
• Consult with internal/external stakeholders to support the utilization/benefit management function.
• Identify members who may benefit from care management and coordinate referrals.
• Promote quality and effectiveness of healthcare services and utilization.

Skills

Behavioral health experience

Strong communication skills

Willingness to travel

Education

Masters-level clinician and/or RN license (AZ)

Job description

CVS Health is seeking a qualified clinician to coordinate and document utilization/benefit management activities for child and adolescent members. You will apply evidence-based criteria and medical necessity guidelines to render coverage decisions and referrals as part of a collaborative care team.

The role requires an active AZ clinical/counseling license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW) and 2+ years of behavioral health experience, with travel up to 10% within the United States.