Clinical Utilization & Benefit Management Specialist

CVS Health Corporation; New Hampshire; Hybrid; USD 54,000 - 156,000; Full time

Benefits offered by this job

Medical coverage

Dental and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health Corporation is seeking a licensed clinician to coordinate, document, and communicate utilization/benefit management activities for child and adolescent members. You will apply medical necessity criteria and collaborate with providers to ensure appropriate services across the continuum of care.

The role requires active AZ licensure (RN/LPC/LAC/LMFT/LMSW/LCSW) and 3+ years in behavioral health utilization, with a 40-hour workweek and potential travel within Phoenix, AZ.

Qualifications

• Active clinical license in good standing (RN, LPC, LAC, LMFT, LMSW, or LCSW)
• Arizona license required for clinical role
• Mon-Fri 8am-5pm (Arizona Time) with possible weekends/holidays
• Travel up to 10% within Phoenix, AZ

Responsibilities

• Coordinate, document, and communicate utilization/benefit management activities.
• Apply medical necessity criteria and guidelines for appropriate utilization of services.
• Consult and lend expertise to internal and external stakeholders in utilization/benefit management.
• Gather clinical information to render coverage determinations and discharge planning.
• Collaborate with providers to facilitate optimal care and treatment across the continuum.

Skills

Communication skills

Organizational & time management

Collaborative teamwork

Critical thinking

Education

Master's degree or RN license in AZ

Tools

Microsoft Word

Microsoft Excel

Job description

CVS Health Corporation is seeking a licensed clinician to coordinate, document, and communicate utilization/benefit management activities for child and adolescent members. You will apply medical necessity criteria and collaborate with providers to ensure appropriate services across the continuum of care.

The role requires active AZ licensure (RN/LPC/LAC/LMFT/LMSW/LCSW) and 3+ years in behavioral health utilization, with a 40-hour workweek and potential travel within Phoenix, AZ.