Clinical Utilization & Care Coordination Consultant

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

Job summary

CVS Health Corporation in Phoenix, AZ, seeks an experienced clinician to coordinate and document utilization/benefit management activities. You will apply medical necessity criteria and collaborate with providers to render coverage determinations and facilitate discharge planning across the care continuum.

The role emphasizes clinical judgment, attention to documentation, and coordination with care teams to optimize benefits and services for members.

Qualifications

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

Responsibilities

• Coordinate, document, and communicate utilization/benefit management activities.
• Apply medical necessity criteria for appropriate service utilization.
• Consult with internal and external stakeholders to coordinate care.
• Gather clinical information and render coverage determinations and referrals.
• Collaborate to evaluate healthcare services and promote quality utilization.
• Identify members who may benefit from care management and referrals.

Skills

Utilization management experience

Behavioral health care

Clinical coordination

Communication skills

Education

Master’s-level clinician and/or RN, licensed in AZ

Tools

Microsoft Office Suite

Electronic documentation systems

Job description

CVS Health Corporation in Phoenix, AZ, seeks an experienced clinician to coordinate and document utilization/benefit management activities. You will apply medical necessity criteria and collaborate with providers to render coverage determinations and facilitate discharge planning across the care continuum.

The role emphasizes clinical judgment, attention to documentation, and coordination with care teams to optimize benefits and services for members.