Clinical Utilization & Care Optimization Consultant

CVS Health Corporation; Minnesota; Hybrid; USD 36,000 - 102,000; Full time

Benefits offered by this job

Medical/dental/vision coverage

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Health Corporation is seeking a licensed clinician to coordinate and document utilization/benefit management activities. You will apply medical necessity criteria, consult with internal and external stakeholders, and guide care decisions across the continuum of care.

The role requires 2+ years in utilization management, active Arizona licensure (RN or eligible), and the ability to work 8am-5pm AZ time with some travel to Phoenix. Excellent communication and documentation skills are essential.

Qualifications

• 2+ years of clinical experience in utilization management.
• Active and good standing Arizona clinical license (RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW).
• Ability to work Monday-Friday 8am-5pm (Arizona Time); 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 judgment to determine medical necessity for services.
• Lend expertise to internal/external constituents in utilization management.
• Gather clinical information and render coverage determinations.
• Collaborate with providers to facilitate appropriate healthcare services.
• Identify members who may benefit from care management and facilitate referrals.

Skills

Clinical experience

Utilization management

Communication skills

Travel readiness

Documentation & EHR

Education

Master’s-level clinician or RN

Tools

Microsoft Office

Electronic health records (EHR)

Job description

CVS Health Corporation is seeking a licensed clinician to coordinate and document utilization/benefit management activities. You will apply medical necessity criteria, consult with internal and external stakeholders, and guide care decisions across the continuum of care.

The role requires 2+ years in utilization management, active Arizona licensure (RN or eligible), and the ability to work 8am-5pm AZ time with some travel to Phoenix. Excellent communication and documentation skills are essential.