Clinical Utilization Management Consultant

CVS Health Corporation; Maine; Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical coverage

Dental & Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation seeks a licensed clinician to coordinate and document utilization/benefit management for child and adolescent members, applying evidence-based criteria and medical necessity guidelines to determine coverage.

You will collaborate with providers and internal teams, collect clinical data, and identify members who may benefit from care management programs, with a 40-hour work week and Arizona licensure required.

Qualifications

• 2+ years of clinical utilization management experience.
• Active Arizona clinical license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW).
• Ability to work 8am–5pm Arizona Time, Monday–Friday; occasional weekends/holidays.
• Travel up to 10% within Phoenix, AZ.

Responsibilities

• Utilizes clinical skills to coordinate, document, and communicate all aspects of utilization/benefit management.
• Applies criteria for appropriate utilization of services for child and adolescent members.
• Consults with internal/external constituents in coordination of utilization/benefit management.
• Gathers clinical information and applies medical necessity criteria to render coverage determinations.
• Collaborates with providers to facilitate optimal care and services.

Skills

Clinical utilization management

Communication

Collaboration

Microsoft Office

Education

Arizona licensed clinician (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW)

Tools

Microsoft Word

Excel

Job description

CVS Health Corporation seeks a licensed clinician to coordinate and document utilization/benefit management for child and adolescent members, applying evidence-based criteria and medical necessity guidelines to determine coverage.

You will collaborate with providers and internal teams, collect clinical data, and identify members who may benefit from care management programs, with a 40-hour work week and Arizona licensure required.