Clinical Utilization & Care Coordination Consultant

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

Job summary

CVS Health is seeking a qualified clinician to coordinate utilization/benefit management for child and adolescent members, applying medical necessity criteria and evidence-based care to determine coverage decisions along the care continuum.

Requirements include 2+ years in behavioral health utilization management, an AZ license (RN/LPC/LAC/LMFT/LCAFT/LMSW/LCSW), and availability 8am–5pm AZ time, with up to 10% travel in Phoenix. Full-time role with comprehensive benefits.

Qualifications

• 2+ years of clinical, behavioral health experience in utilization management.
• Active and good standing AZ clinical and/or counseling license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW).
• Ability to work 8am-5pm Arizona Time, with occasional weekends/holidays.
• Travel up to 10% within Phoenix, AZ.

Responsibilities

• Coordinate, document, and communicate utilization/benefit management.
• Apply clinical criteria and medical necessity to determine coverage decisions.
• Consult with internal/external stakeholders in utilization/benefit management.
• Gather clinical information to render coverage determination/recommendation.
• Collaborate to evaluate and facilitate appropriate healthcare services.
• Coordinate with providers to facilitate optimal care.
• Identify members who may benefit from care management referrals.
• Identify opportunities to improve quality and utilization of services.
• Sedentary work involving sitting, talking, and listening.

Skills

Clinical utilization management

Behavioral health experience

Arizona license eligibility

Communication skills

Time management

MS Office proficiency

Education

Master’s degree or RN license in AZ

Tools

Microsoft Office (Word & Excel)

Job description

CVS Health is seeking a qualified clinician to coordinate utilization/benefit management for child and adolescent members, applying medical necessity criteria and evidence-based care to determine coverage decisions along the care continuum.

Requirements include 2+ years in behavioral health utilization management, an AZ license (RN/LPC/LAC/LMFT/LCAFT/LMSW/LCSW), and availability 8am–5pm AZ time, with up to 10% travel in Phoenix. Full-time role with comprehensive benefits.