Clinical Utilization Strategist

CVS Health Corporation; Iowa (LA); Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation is seeking a qualified clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program for pediatric and adolescent members. You will apply evidence-based criteria and medical necessity guidelines to determine appropriate services and collaborate with providers to optimize care.

The role requires an active Arizona clinical license (RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW) and at least 2+ years in clinical/behavioral health

Qualifications

• 2+ years of clinical/behavioral health experience in 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) and occasional weekends/holidays.
• Ability to travel up to 10% within Phoenix, AZ.

Responsibilities

• Coordinate and communicate all aspects of the utilization/benefit management program.
• Apply medical necessity criteria and guidelines for appropriate utilization of services for child/adolescent members.
• Consult with internal/external stakeholders in utilization/benefit management.
• Render coverage determinations and referrals along the continuum of care.
• Collaborate with providers to facilitate optimal care and transitions.
• Identify members who may benefit from care management and refer accordingly.
• Promote quality and effectiveness of healthcare services and benefit utilization.
• Sedentary work involving sitting, talking, and listening.

Skills

Clinical experience

Behavioral health

Utilization management

Microsoft Office

Communication skills

Time management

Collaboration

Education

Master’s-level clinician

RN license (AZ)

Tools

Word

Excel

Job description

CVS Health Corporation is seeking a qualified clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program for pediatric and adolescent members. You will apply evidence-based criteria and medical necessity guidelines to determine appropriate services and collaborate with providers to optimize care.

The role requires an active Arizona clinical license (RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW) and at least 2+ years in clinical/behavioral health