Clinical Utilization & Care Coordination Specialist

CVS Health Corporation; Virginia (MN); Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a full-time Utilization Management clinician to coordinate and document the utilization/benefit management process. You’ll apply clinical judgment and evidence-based criteria to determine medical necessity for child/adolescent services and collaborate with providers to coordinate care.

Ideal candidates have at least 2 years in utilization management, hold an Arizona clinical license, and can work standard Arizona hours with occasional travel.

Qualifications

• 2+ years of clinical experience in utilization management.
• Active and good standing Arizona clinical and/or counseling license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW).
• Ability to work 8am–5pm Arizona Time, with some weekends/holidays and up to 10% travel.

Responsibilities

• Coordinate, document, and communicate utilization/benefit management activities.
• Apply clinical judgment to determine medical necessity and care plan.
• Collaborate with providers and internal/external stakeholders to optimize care.
• Identify members for care management and promote program effectiveness.
• Triage and address urgent or emergent situations as needed.

Skills

Clinical coordination

Documentation

Communication skills

Team collaboration

Education

Master’s-level clinician and/or RN

Tools

Word

Excel

Job description

CVS Health is seeking a full-time Utilization Management clinician to coordinate and document the utilization/benefit management process. You’ll apply clinical judgment and evidence-based criteria to determine medical necessity for child/adolescent services and collaborate with providers to coordinate care.

Ideal candidates have at least 2 years in utilization management, hold an Arizona clinical license, and can work standard Arizona hours with occasional travel.