Clinical Utilization & Care Coordination Consultant

Inspire Health Alliance; California, Northern (MO, KY); Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health seeks a clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program for child and adolescent members. You will apply medical necessity criteria and collaborate with providers and internal teams to render coverage determinations and referrals across the continuum of care.

The role supports a 40-hour work week in Arizona, with travel up to 10% within the Phoenix area.

Qualifications

• 2+ years in utilization management or clinical setting.
• Active Arizona license (RN/LMFT/LCSW/LPC) in good standing.
• Ability to work 8am–5pm AZ time plus weekends/holidays as needed.
• Travel up to 10% within Phoenix, AZ.

Responsibilities

• Coordinate, document, and communicate utilization/benefit management activities.
• Apply medical necessity criteria and guidelines for coverage decisions.
• Consult with providers and internal teams to optimize care.
• Identify and refer members to appropriate care management programs.

Skills

Clinical utilization management

Communication skills

Time management

Education

Master's degree or RN license

Tools

Microsoft Office (Word, Excel)

Electronic health records (EMR) systems

Job description

CVS Health seeks a clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program for child and adolescent members. You will apply medical necessity criteria and collaborate with providers and internal teams to render coverage determinations and referrals across the continuum of care.

The role supports a 40-hour work week in Arizona, with travel up to 10% within the Phoenix area.