Clinical Utilization Management Specialist

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

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health Corporation is seeking a full-time clinical professional to coordinate and document utilization/benefit management for members across care settings. You will apply medical necessity criteria and collaborate with providers to render coverage decisions and discharge planning.

The role requires an active Arizona clinical license (RN or eligible) with 2+ years in utilization management, strong communication, and flexibility for travel up to 10% within the Phoenix area if needed.

Qualifications

• 2+ years in clinical or behavioral health utilization management.
• Active Arizona clinical license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW).
• Ability to work 8am–5pm Arizona time, some weekends/holidays.

Responsibilities

• Coordinate and document utilization/benefit management activities.
• Apply medical necessity criteria and guidelines for coverage decisions.
• Collaborate with providers and internal/external stakeholders to optimize care.
• Identify members for care management and facilitate referrals.
• Promote quality and effectiveness of healthcare services.

Skills

Clinical utilization management

Strong communication

Arizona license

Travel readiness

Education

Master's-level clinician or RN, AZ licensed

Job description

CVS Health Corporation is seeking a full-time clinical professional to coordinate and document utilization/benefit management for members across care settings. You will apply medical necessity criteria and collaborate with providers to render coverage decisions and discharge planning.

The role requires an active Arizona clinical license (RN or eligible) with 2+ years in utilization management, strong communication, and flexibility for travel up to 10% within the Phoenix area if needed.