Clinical Utilization & Care Management Consultant

CVS Health Corporation; Nevada (IA); Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Retirement savings

Paid time off

Wellness programs

Job summary

CVS Health Corporation is seeking a licensed clinical professional to join our utilization/benefit management team in Arizona. This full‑time role coordinates, documents, and communicates all aspects of utilization management for child and adolescent members, applying medical necessity criteria and evidence‑based care.

The position requires 2+ years in clinical utilization management, AZ licensure (RN/LPC/LCSW etc.), and the ability to work 8am–5pm AZ time with occasional weekends and up to 10%

Qualifications

• 2+ years of clinical, behavioral health setting, working directly with utilization management.
• Active and good standing Arizona clinical and/or counseling license (RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW).
• Ability to work Monday-Friday 8am-5pm (Arizona Time), plus occasional weekends/holidays as needed.
• Ability to travel up to 10% of the time within Phoenix, AZ.

Responsibilities

• Coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Apply clinical knowledge to render coverage determinations and care recommendations.
• Consult with internal/external constituents in utilization/benefit management.
• Gather clinical information and apply medical necessity criteria to determine care.
• Collaborate with providers to facilitate optimal care and treatment.
• Identify members who may benefit from care management and facilitate referrals.
• Identify opportunities to improve quality and efficiency of services.
• Sedentary work involving periods of sitting, talking, and listening.

Skills

Utilization management

Clinical coordination

Communication skills

Education

Master's-level clinician or RN, AZ licensed

Tools

Microsoft Office

Word

Excel

Job description

CVS Health Corporation is seeking a licensed clinical professional to join our utilization/benefit management team in Arizona. This full‑time role coordinates, documents, and communicates all aspects of utilization management for child and adolescent members, applying medical necessity criteria and evidence‑based care.

The position requires 2+ years in clinical utilization management, AZ licensure (RN/LPC/LCSW etc.), and the ability to work 8am–5pm AZ time with occasional weekends and up to 10%