Clinical Utilization & Care Coordination Specialist

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

Benefits offered by this job

Bonus eligibility

Comprehensive benefits package

Job summary

CVS Health Corporation in Arizona is seeking a qualified clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program. The role emphasizes evidence-based care and medical necessity criteria for child and adolescent members.

You will collaborate with providers and internal teams, gather clinical information, render coverage determinations, and refer eligible members to care management.

Qualifications

• 2+ years of clinical experience in utilization management.
• Active Arizona clinical license (RN, LPC, LAC, LMFT, LMAFT, LMSW or LCSW).
• Ability to work 8am-5pm Arizona Time, with occasional weekends/holidays.
• Up to 10% travel within Phoenix, AZ.

Responsibilities

• Coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Apply clinical judgment to determine medical necessity for child/adolescent members.
• Consult with internal and external constituents on utilization management.
• Render coverage determinations and discharge planning along the care continuum.
• Collaborate with providers to facilitate optimal care and treatment.
• Identify members who may benefit from care management referrals.
• Promote quality and efficiency of healthcare services and benefit utilization.
• Sedentary work involving sitting, talking, and listening.

Skills

Utilization management

Clinical coordination

Arizona license

Microsoft Office

Communication skills

Time management

Education

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

Tools

Microsoft Office Suite

Job description

CVS Health Corporation in Arizona is seeking a qualified clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program. The role emphasizes evidence-based care and medical necessity criteria for child and adolescent members.

You will collaborate with providers and internal teams, gather clinical information, render coverage determinations, and refer eligible members to care management.