Clinical Utilization & Benefits Management Consultant

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

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a licensed behavioral health professional to coordinate utilization/benefit management activities for members across the care continuum. The role emphasizes applying evidence-based criteria and clinical judgment to determine appropriate services, with a focus on child and adolescent care.

The position requires an active Arizona license (RN or LCSW/LPC/LMFT variants) and a willingness to work 8am–5pm Arizona time, with occasional weekend/holiday coverage and up to 10%

Qualifications

• 2+ years of behavioral health experience.
• Active Arizona clinical/counseling license (RN, LPC, LAC, LMFT, LMAFT, LMSW or LCSW).
• Willingness to work 8am-5pm Arizona Time, Mon-Fri with occasional weekends/holidays.
• Willingness to travel up to 10% within the United States.

Responsibilities

• Coordinate, document, and communicate utilization/benefit management activities.
• Apply clinical judgment to determine medical necessity and coverage.
• Collaborate with providers and internal/external stakeholders.
• Identify members who may benefit from care management and referrals.
• Promote quality and effectiveness of healthcare services.

Skills

Behavioral health experience

Communication skills

Time management

Schedule flexibility

Education

Master's degree or RN

Arizona license

Job description

CVS Health is seeking a licensed behavioral health professional to coordinate utilization/benefit management activities for members across the care continuum. The role emphasizes applying evidence-based criteria and clinical judgment to determine appropriate services, with a focus on child and adolescent care.

The position requires an active Arizona license (RN or LCSW/LPC/LMFT variants) and a willingness to work 8am–5pm Arizona time, with occasional weekend/holiday coverage and up to 10%