Clinical Utilization & Care Coordination Specialist

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

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation seeks a clinically skilled professional to coordinate utilization/benefit management for child and adolescent members. The role requires licensure in Arizona and 2+ years of related clinical experience, with 40-hour weeks and occasional travel.

This full-time position offers comprehensive benefits, opportunities to collaborate across departments, and the chance to impact patient care across the Phoenix area.

Qualifications

• 2+ years of clinical, behavioral health experience in utilization management.
• Active Arizona clinical license (RN or eligible licensure categories).
• Work Monday-Friday 8am-5pm (Arizona Time), with occasional 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 utilization of services for child and adolescent members.
• Lend expertise to internal and external constituents in utilization/benefit management.
• Coordinate with providers to facilitate optimal care and identify members for care management.

Skills

Clinical experience

AZ licensed

Microsoft Office

Communication skills

Time management

Education

Master's degree or RN license

Tools

Word

Excel

Job description

CVS Health Corporation seeks a clinically skilled professional to coordinate utilization/benefit management for child and adolescent members. The role requires licensure in Arizona and 2+ years of related clinical experience, with 40-hour weeks and occasional travel.

This full-time position offers comprehensive benefits, opportunities to collaborate across departments, and the chance to impact patient care across the Phoenix area.