Clinical Utilization & Care Management Consultant

CVS Health Corporation; Washington (District of Columbia); Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Bonus program

Paid time off

Job summary

CVS Health Corporation is seeking a licensed clinician to coordinate, document, and communicate utilization management across the continuum of care. You will apply evidence-based criteria to inform coverage decisions, consult with internal and external stakeholders, and facilitate appropriate healthcare services for members.

Travel to Phoenix area may be required. Ideal candidates have 2+ years in utilization management, Arizona licensure, and strong office-based technical skills.

Qualifications

• 2+ years of clinical experience in utilization management.
• Arizona license: RN, LPC, LAC, LMFT, LMAFT, LMSW or LCSW in good standing.
• Availability to work 8am-5pm Arizona Time, Monday–Friday, with weekends/holidays as needed.
• Travel up to 10% within Phoenix, AZ.

Responsibilities

• Coordinate, document, and communicate utilization management activities.
• Apply medical necessity criteria and guidelines for coverage decisions.
• Consult with internal/external stakeholders to optimize care.
• Gather clinical information to render determinations and referrals.
• Collaborate with providers to facilitate appropriate care/treatment.
• Identify members who may benefit from care management programs.

Skills

Utilization management

Clinical coordination

Patient communication

Microsoft Office

Multitasking

Education

Master's degree in clinical field

Arizona RN license

Tools

Electronic health records (EHR)

Microsoft Office

Word

Excel

Job description

CVS Health Corporation is seeking a licensed clinician to coordinate, document, and communicate utilization management across the continuum of care. You will apply evidence-based criteria to inform coverage decisions, consult with internal and external stakeholders, and facilitate appropriate healthcare services for members.

Travel to Phoenix area may be required. Ideal candidates have 2+ years in utilization management, Arizona licensure, and strong office-based technical skills.