Clinical Utilization & Care Coordination Consultant

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a clinician to coordinate and document utilization/benefit management for behavioral health. You will apply evidence-based criteria and medical judgment to determine care needs for child and adolescent members, consulting with internal and external stakeholders to ensure appropriate services.

Applicants should have 2+ years of behavioral health experience and an Arizona license type. This full-time role requires Arizona time work hours, occasional travel, and comprehensive

Qualifications

• 2+ years of behavioral health experience.
• Active and good standing Arizona clinical and/or counseling license (RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW).
• Willingness to work Monday–Friday 8am–5pm (Arizona Time), with occasional weekends/holidays.
• Willingness to travel up to 10% within the United States.

Responsibilities

• Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Applies critical thinking and knowledge in evidence-based care and medical necessity criteria for child/adolescent utilization.
• Consults and lends expertise to internal and external constituents in utilization/benefit management.
• Gathers clinical information and applies medical necessity criteria to render coverage decisions and discharge planning.
• Uses clinical experience to evaluate and facilitate appropriate healthcare services for members, including triage/crisis support.
• Coordinates and communicates with providers to facilitate optimal care/treatment.
• Identifies members who may benefit from care management and facilitates referrals.
• Identifies opportunities to promote quality and effectiveness of services and utilization.
• Sedentary work involving periods of sitting, talking, and listening.

Skills

Behavioral health experience

Communication skills

Time management

Collaboration

Education

Masters-level clinician or RN

Job description

CVS Health is seeking a clinician to coordinate and document utilization/benefit management for behavioral health. You will apply evidence-based criteria and medical judgment to determine care needs for child and adolescent members, consulting with internal and external stakeholders to ensure appropriate services.

Applicants should have 2+ years of behavioral health experience and an Arizona license type. This full-time role requires Arizona time work hours, occasional travel, and comprehensive