Clinical Utilization & Care Management Consultant

CVS Health Corporation; Town of Texas (WI); Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health Corporation is seeking a clinically skilled professional to coordinate, document, and communicate utilization/benefit management activities for child and adolescent members. The role emphasizes evidence-based care, medical necessity criteria, and collaboration with providers to facilitate appropriate services.

The ideal candidate has 2+ years in clinical/behavioral health settings with utilization management, holds an AZ license (RN or eligible), and is available to work Mon-Fri

Qualifications

• 2+ years of clinical, behavioral health setting experience, 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); occasional weekends/holidays as needed.
• Travel up to 10% of the time within Phoenix, AZ.

Responsibilities

• Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Applies evidence-based care and medical necessity criteria for appropriate utilization of services for child and adolescent members.
• Consults and lends expertise to internal and external constituents in coordination and administration of utilization/benefit management.
• Gathers clinical information and applies criteria to render coverage determination/recommendation/discharge planning.
• Evaluates and facilitates appropriate healthcare services/benefits for members, including urgent interventions.
• Coordinates and communicates with providers to facilitate optimal care/treatment.
• Identifies members who may benefit from care management programs and facilitates referral.
• Identifies opportunities to promote quality and effectiveness of healthcare services.

Skills

Communication

Time management

Organizational skills

Documentation

Microsoft Office

Education

Master's degree or AZ RN license

Tools

Microsoft Word

Excel

Job description

CVS Health Corporation is seeking a clinically skilled professional to coordinate, document, and communicate utilization/benefit management activities for child and adolescent members. The role emphasizes evidence-based care, medical necessity criteria, and collaboration with providers to facilitate appropriate services.

The ideal candidate has 2+ years in clinical/behavioral health settings with utilization management, holds an AZ license (RN or eligible), and is available to work Mon-Fri