Clinical Utilization Management Consultant

CVS Health Corporation; California (MO); Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus program

401(k) plan

Job summary

CVS Health Corporation is seeking a clinician to coordinate the utilization/benefit management program. You will apply clinical judgment, criteria, and documentation to determine appropriate care and coverage for members, including urgent or crisis interventions.

The role requires a Master’s level clinician or RN licensed in Arizona, with 2+ years in utilization management and strong collaboration with providers to optimize care and outcomes.

Qualifications

• 2+ years of clinical, behavioral health setting, working directly with utilization management.
• Active and good standing Arizona clinical and/or counseling license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW).
• 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 all aspects of the utilization/benefit management program.
• Apply medical necessity criteria to determine coverage and discharge planning.
• Consult with internal/external stakeholders to support utilization management functions.
• Gather clinical information to render coverage determinations and recommendations.

Skills

Utilization management

Clinical experience

Communication skills

Education

Master's level clinician or RN

Tools

Microsoft Office

Word

Excel

Job description

CVS Health Corporation is seeking a clinician to coordinate the utilization/benefit management program. You will apply clinical judgment, criteria, and documentation to determine appropriate care and coverage for members, including urgent or crisis interventions.

The role requires a Master’s level clinician or RN licensed in Arizona, with 2+ years in utilization management and strong collaboration with providers to optimize care and outcomes.