Clinical Utilization & Care Management Consultant

CVS Health Corporation; New York (NY); Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical, dental, and vision Coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in Arizona is seeking a licensed clinician to coordinate, document, and communicate utilization/benefit management activities across the care continuum. The role requires applying evidence-based criteria and medical necessity for services, collaborating with providers, and guiding care decisions while ensuring high quality and efficient patient outcomes.

This full-time position offers a structured schedule and industry-leading benefits.

Qualifications

• 2+ years of clinical experience in utilization management or related setting.
• Arizona license: RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW in good standing.
• Ability to work 8am–5pm (AZ Time) with some weekends/holidays.
• Travel up to 10% within Phoenix, AZ.

Responsibilities

• Coordinate, document, and communicate utilization/benefit management activities.
• Apply evidence-based criteria and medical necessity for services.
• Lend clinical expertise to internal and external stakeholders.
• Gather clinical information to render coverage determinations.
• Collaborate with providers to facilitate optimal care.
• Identify members for care management referrals.
• Promote quality, effectiveness, and appropriate utilization.

Skills

Clinical utilization management

Care coordination

Communication with stakeholders

Critical thinking

Education

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

Tools

Microsoft Office (Word & Excel)

Job description

CVS Health in Arizona is seeking a licensed clinician to coordinate, document, and communicate utilization/benefit management activities across the care continuum. The role requires applying evidence-based criteria and medical necessity for services, collaborating with providers, and guiding care decisions while ensuring high quality and efficient patient outcomes.

This full-time position offers a structured schedule and industry-leading benefits.