Clinical Utilization & Care Coordination Consultant

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

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation is seeking a clinician to coordinate utilization management and evidence-based care for members. You will apply medical necessity criteria and collaborate with providers to ensure appropriate services are delivered efficiently.

The role requires clinical licensure in Arizona, 2+ years in utilization management, and the ability to work 8am–5pm AZ time with some travel up to 10%. This is a full-time position with comprehensive benefits.

Qualifications

• 2+ years in clinical utilization management or similar setting.
• Active Arizona clinical license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW).
• Ability to work 8am–5pm Arizona Time, weekdays, with occasional weekends.

Responsibilities

• Coordinate, document, and communicate utilization/benefit management.
• Apply clinical criteria to determine medical necessity and coverage.
• Lend expertise across internal/external stakeholders in utilization management.
• Gather clinical data to render coverage determinations and discharge planning.
• Collaborate with providers to facilitate appropriate care and referrals.

Skills

Utilization management

Clinical coordination

Communication skills

Travel flexibility

Education

Master's degree or RN license (AZ)

Tools

Microsoft Word & Excel

Job description

CVS Health Corporation is seeking a clinician to coordinate utilization management and evidence-based care for members. You will apply medical necessity criteria and collaborate with providers to ensure appropriate services are delivered efficiently.

The role requires clinical licensure in Arizona, 2+ years in utilization management, and the ability to work 8am–5pm AZ time with some travel up to 10%. This is a full-time position with comprehensive benefits.