Clinical Utilization Navigator for Care Coordination

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

Job summary

CVS Health in Arizona is seeking a clinical utilization management professional to coordinate, document, and communicate all aspects of the utilization/benefit management program, applying medical necessity criteria and evidence-based care.

You will collaborate with providers and internal teams, identify members who may benefit from care management, and support triage and discharge planning across the continuum of care.

Qualifications

• 2+ years of clinical utilization management in behavioral health.
• Active Arizona clinical license (RN, LPC, LAC, LMFT, LMAFT, LMSW or LCSW).
• Ability to work 8am-5pm Arizona Time, Mon-Fri, with some weekends/holidays.
• Up to 10% travel within Phoenix, AZ.

Responsibilities

• Coordinate, document, and communicate utilization/benefit management activities.
• Apply medical necessity criteria and evidence-based guidelines for appropriate care.
• Consult with internal/external partners to facilitate coverage decisions and discharge planning.
• Identify members for care management and coordinate referrals with providers.

Skills

Utilization management

Communication skills

Collaboration

Time management

Education

Master's-level clinician / RN

Tools

Microsoft Word

Microsoft Excel

Job description

CVS Health in Arizona is seeking a clinical utilization management professional to coordinate, document, and communicate all aspects of the utilization/benefit management program, applying medical necessity criteria and evidence-based care.

You will collaborate with providers and internal teams, identify members who may benefit from care management, and support triage and discharge planning across the continuum of care.