Clinical Utilization & Care Coordination Consultant

CVS Health Corporation; Nebraska; Hybrid; USD 74,390,000 - 213,528,000; Full time

Job summary

CVS Health Corporation seeks a clinically skilled professional to coordinate utilization/benefit management for child and adolescent members. You will apply medical necessity criteria and collaborate with providers to render coverage determinations.

The role requires 2+ years in a clinical/utilization setting, an active AZ license (RN/LPC/LCSW variants), and full-time hours with some travel. Strong communication and organization are essential.

Qualifications

• 2+ years of clinical/behavioral health experience in utilization management.
• Active and good standing Arizona clinical license (RN, LPC, LAC, LMFT, LMAFT, LMSW or LCSW).
• Monday–Friday 8am–5pm Arizona Time; occasional weekends/holidays; travel up to 10%.
• Strong communication, organization, and teamwork skills.

Responsibilities

• Coordinate, document, and communicate utilization/benefit management activities.
• Apply medical necessity criteria and guidelines to determine coverage decisions.
• Collaborate with providers and internal/external stakeholders to coordinate care.
• Identify members for care management and facilitate referrals and discharge planning.
• Support quality and efficiency improvements in service utilization.

Skills

Utilization management

Communication skills

Collaboration

Critical thinking

Education

Master's-level clinician or RN license (AZ)

Tools

Microsoft Office Suite

Job description

CVS Health Corporation seeks a clinically skilled professional to coordinate utilization/benefit management for child and adolescent members. You will apply medical necessity criteria and collaborate with providers to render coverage determinations.

The role requires 2+ years in a clinical/utilization setting, an active AZ license (RN/LPC/LCSW variants), and full-time hours with some travel. Strong communication and organization are essential.