Clinical Utilization & Care Coordination Consultant

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

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health seeks a clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program, applying clinical judgment to render coverage determinations for pediatric members.

Requirements include 2+ years of behavioral health experience, an active Arizona license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW), and the ability to work 8am–5pm AZ time with up to 10% travel within the United States.

Qualifications

• 2+ years of behavioral health experience.
• Active AZ clinical license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW).
• Willingness to work Monday–Friday 8am–5pm (AZ Time).
• Willingness to travel up to 10% within the United States.

Responsibilities

• Coordinate, document, and communicate all aspects of utilization/benefit management.
• Apply clinical judgment to determine medical necessity and coverage.
• Consult with providers and internal/external constituents on care management.
• Gather clinical information and render coverage determinations and discharge planning.
• Identify members who may benefit from care management programs.

Skills

Behavioral health experience

Licensure in AZ (RN/LPC/LAC/LMFT/LMAFT

Education

Masters-level clinician or RN licensed in AZ

Job description

CVS Health seeks a clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program, applying clinical judgment to render coverage determinations for pediatric members.

Requirements include 2+ years of behavioral health experience, an active Arizona license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW), and the ability to work 8am–5pm AZ time with up to 10% travel within the United States.