Clinical Utilization & Care Coordination Consultant

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Wellness programs

Job summary

CVS Health Corporation is seeking a full-time Utilization Management Clinician to coordinate and document all aspects of our utilization/benefit management program across child and adolescent care. You will apply medical necessity criteria, consult with stakeholders, and support coverage determinations and discharge planning.

Role requires Arizona-licensed clinicians, 2+ years in clinical/behavioral health UM, and ability to travel up to 10% while working 8am–5pm Arizona Time.

Qualifications

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

Responsibilities

• Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Applies criteria for appropriate utilization and medical necessity in child/adolescent care.
• Consults with internal/external stakeholders to coordinate utilization management.
• Reviews clinical information to render coverage determinations and discharge planning.
• Collaborates with providers to facilitate optimal care and treatment.
• Identifies members who may need care management and facilitates referrals.
• Looks for opportunities to improve quality and efficiency of services.
• Sits and communicates with colleagues; comfortable with computer-based work.

Skills

Clinical UM experience

Behavioral health

Communication skills

Time management

Education

Arizona licensed clinician (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW)

Tools

Microsoft Word

Microsoft Excel

Job description

CVS Health Corporation is seeking a full-time Utilization Management Clinician to coordinate and document all aspects of our utilization/benefit management program across child and adolescent care. You will apply medical necessity criteria, consult with stakeholders, and support coverage determinations and discharge planning.

Role requires Arizona-licensed clinicians, 2+ years in clinical/behavioral health UM, and ability to travel up to 10% while working 8am–5pm Arizona Time.