Clinical Utilization & Care Coordination Specialist

CVS Health Corporation; Massachusetts; Hybrid; USD 54,000 - 156,000; Full time

Job summary

CVS Health in Massachusetts seeks a licensed clinician to coordinate utilization/benefit management, applying medical necessity criteria for child and adolescent members.

You will gather clinical information, render coverage decisions, and collaborate with providers to optimize care. Requires 2+ years in utilization management and an active AZ license, with occasional travel as needed.

Qualifications

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

Responsibilities

• Coordinate, document, and communicate utilization/benefit management activities.
• Apply medical necessity criteria and guidelines for appropriate service utilization.
• Consult with internal/external partners to administer utilization/benefit management.
• Render coverage determinations and discharge planning across the care continuum.
• Collaborate with providers to facilitate optimal care and referrals.

Skills

Behavioral health experience

Clinical utilization management

Microsoft Word

Microsoft Excel

Education

Master’s-level clinician / RN license

Tools

Microsoft Word

Microsoft Excel

Job description

CVS Health in Massachusetts seeks a licensed clinician to coordinate utilization/benefit management, applying medical necessity criteria for child and adolescent members.

You will gather clinical information, render coverage decisions, and collaborate with providers to optimize care. Requires 2+ years in utilization management and an active AZ license, with occasional travel as needed.