Clinical Utilization & Care Coordination Specialist

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

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an experienced clinician to coordinate and document utilization/benefit management activities. The role focuses on applying medical necessity criteria for child/adolescent care and consulting with stakeholders to render coverage decisions and discharge planning.

The position requires an active Arizona license (RN, LPC, LAC, LMFT, LMAFT, LMSW or LCSW) and 2+ years in clinical or behavioral health settings, with work hours 8am–5pm AZ time and up to 10% travel within Phoenix.

Qualifications

• 2+ years of experience in clinical or behavioral health settings with utilization management.
• Active and good standing Arizona clinical license (RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW).
• Ability to work Monday-Friday 8am-5pm Arizona 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 stakeholders on utilization/benefit management.
• Gather clinical information to render coverage determinations and discharge planning.
• Collaborate with providers to facilitate optimal care and referrals.
• Identify members who may benefit from care management programs.

Skills

Utilization management

Clinical skills

Communication skills

Time management

Education

Master’s-level clinician

Tools

Microsoft Office

Word

Excel

Job description

CVS Health is seeking an experienced clinician to coordinate and document utilization/benefit management activities. The role focuses on applying medical necessity criteria for child/adolescent care and consulting with stakeholders to render coverage decisions and discharge planning.

The position requires an active Arizona license (RN, LPC, LAC, LMFT, LMAFT, LMSW or LCSW) and 2+ years in clinical or behavioral health settings, with work hours 8am–5pm AZ time and up to 10% travel within Phoenix.