Clinical Utilization & Care Management Consultant

CVS Health Corporation; Indiana (PA); Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Job summary

CVS Health Corporation is seeking a full-time clinician to coordinate and document utilization/benefit management for child and adolescent members in Arizona. The role emphasizes evidence-based care, medical necessity criteria, and collaboration with providers.

You will apply clinical judgment to determine coverage, communicate with stakeholders, and facilitate referrals to care management as needed. Strong organizational and communication skills are essential.

Qualifications

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

Responsibilities

• Coordinate, document and communicate all aspects of the utilization/benefit management program.
• Apply clinical judgment to render coverage determinations/recommendations.
• Consult with internal/external stakeholders on utilization/benefit management.
• Identify members who may need care management and facilitate referrals.
• Collaborate with providers to optimize care and treatment.
• Ensure accurate documentation and data entry across systems.

Skills

Communication

Organization

Time management

Education

Master's-level clinician and/or RN

Tools

Microsoft Office Suite

Job description

CVS Health Corporation is seeking a full-time clinician to coordinate and document utilization/benefit management for child and adolescent members in Arizona. The role emphasizes evidence-based care, medical necessity criteria, and collaboration with providers.

You will apply clinical judgment to determine coverage, communicate with stakeholders, and facilitate referrals to care management as needed. Strong organizational and communication skills are essential.