Clinical Utilization & Care Coordination Consultant

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Wellness programs

Equal opportunity employer

Job summary

CVS Health Corporation in Arizona is seeking a licensed clinician to coordinate and document utilization/benefit management for child and adolescent members, applying medical necessity criteria and evidence-based guidelines.

The role requires 2+ years in utilization management in a clinical or behavioral health setting, an active AZ license (RN or LP...). You will collaborate with providers, identify patients for care management, and support high-quality, cost-effective care.

Qualifications

• 2+ years in clinical or behavioral health utilization management.
• Active AZ clinical license (RN, LPC, LAC, LMFT, LMAFT, LMSW or LCSW).

Responsibilities

• Coordinate, document, and communicate all aspects of utilization/benefit management.
• Apply medical necessity criteria and evidence-based guidelines for pediatric care.
• Consult with internal/external stakeholders to administer the program.
• Render coverage determinations and care planning along the continuum.
• Collaborate with providers to facilitate appropriate healthcare services.

Skills

Clinical coordination

Communication skills

Time management

Team collaboration

Education

Master’s-level clinician or AZ RN license

Tools

Microsoft Office

Job description

CVS Health Corporation in Arizona is seeking a licensed clinician to coordinate and document utilization/benefit management for child and adolescent members, applying medical necessity criteria and evidence-based guidelines.

The role requires 2+ years in utilization management in a clinical or behavioral health setting, an active AZ license (RN or LP...). You will collaborate with providers, identify patients for care management, and support high-quality, cost-effective care.