Clinical Utilization & Care Coordination Consultant

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

Benefits offered by this job

Medical benefits

Dental & vision

Paid time off

Retirement savings

Job summary

CVS Health is hiring a licensed clinician to coordinate, document, and communicate utilization/benefit management for child and adolescent members in the Phoenix area. The role emphasizes applying evidence-based criteria, collaborating with providers, and supporting discharge planning across the care continuum.

Required are 2+ years in a clinical/behavioral health setting with utilization management and an active AZ license (RN, LPC, LAC, LMFT, LMAFT, LMSW or LCSW).

Qualifications

• 2+ years in clinical/behavioral health setting with utilization management

Responsibilities

• Coordinate, document, and communicate utilization/benefit management activities
• Apply medical necessity criteria and guidelines for coverage determinations
• Collaborate with providers and internal/external stakeholders to facilitate care
• Identify members who may benefit from care management and referrals
• Promote quality and effectiveness of healthcare services and benefit utilization
• Note: all duties are within standard full-time hours and Arizona time zone

Skills

Clinical UM experience

Communication skills

Team collaboration

Education

Master’s-level clinician or RN licensed in AZ

Tools

Microsoft Word

Microsoft Excel

Job description

CVS Health is hiring a licensed clinician to coordinate, document, and communicate utilization/benefit management for child and adolescent members in the Phoenix area. The role emphasizes applying evidence-based criteria, collaborating with providers, and supporting discharge planning across the care continuum.

Required are 2+ years in a clinical/behavioral health setting with utilization management and an active AZ license (RN, LPC, LAC, LMFT, LMAFT, LMSW or LCSW).