Clinical Utilization Consultant — Care Optimization

CVS Health Corporation; North Carolina; Hybrid; USD 74,501,000 - 213,528,000; Full time

Job summary

CVS Health Corporation in Phoenix, AZ is seeking a licensed clinician to coordinate, document, and communicate utilization/benefit management activities for child and adolescent members, applying clinical judgment and evidence‑based criteria to determine coverage decisions.

The role requires 2+ years in clinical behavioral health, an active Arizona license (RN, LPC, LAC, LMFT, LMSW, or LCSW), and availability Monday–Friday 8am–5pm (Arizona Time) with occasional weekends and up to 10% travel.

Qualifications

• 2+ years of clinical, behavioral health experience directly in utilization management.
• Active and good standing Arizona clinical license (RN/LPC/LCSW/etc.).
• Ability to work Monday–Friday 8am–5pm (Arizona Time) with occasional weekends/holidays.
• Ability to travel up to 10% within Phoenix, AZ.

Responsibilities

• Coordinate, document, and communicate utilization/benefit management activities.
• Apply clinical judgment and evidence-based criteria for coverage decisions.
• Consult with internal/external stakeholders to optimize care and benefits.
• Identify and refer members to care management programs as appropriate.
• Support quality and efficiency in healthcare service utilization.

Skills

Utilization management experience

Education

Arizona licensed clinician (RN/LPC/LMSW/LCSW)

Job description

CVS Health Corporation in Phoenix, AZ is seeking a licensed clinician to coordinate, document, and communicate utilization/benefit management activities for child and adolescent members, applying clinical judgment and evidence‑based criteria to determine coverage decisions.

The role requires 2+ years in clinical behavioral health, an active Arizona license (RN, LPC, LAC, LMFT, LMSW, or LCSW), and availability Monday–Friday 8am–5pm (Arizona Time) with occasional weekends and up to 10% travel.