Clinical Utilization Strategist

CVS Health Corporation; Oklahoma; Hybrid; USD 54,000 - 156,000; Full time

Benefits offered by this job

Comprehensive benefits

Job summary

CVS Health is seeking a full-time clinician to coordinate utilization/benefit management services in Arizona. The role requires applying medical necessity criteria, documenting decisions, and collaborating with providers to optimize patient care.

The candidate should have a Master’s degree or an AZ-licensed RN/clinical credential, 2+ years in utilization management, and be able to work 8am-5pm AZ time with occasional weekends. Up to 10% travel to Phoenix, AZ.

Qualifications

• 2+ years of clinical experience in utilization management.
• AZ license (RN or eligible LPC/LCSW/etc) in good standing.
• Mon-Fri 8am-5pm AZ time; possible weekends/holidays.
• Travel up to 10% within Phoenix, AZ.

Responsibilities

• Coordinate, document, and communicate utilization/benefit management activities.
• Apply clinical criteria to medical necessity and coverage decisions.
• Lend expertise to internal/external partners in utilization management.
• Gather clinical data to render coverage determinations.
• Collaborate with providers to facilitate appropriate care.
• Identify members who may benefit from care management.
• Promote quality and efficiency in benefit utilization.
• Sedentary work involving sitting, talking, listening.

Skills

Clinical experience

Utilization management

Arizona license

Mon-Fri 8am-5pm

Travel 10%

Communication skills

Time management

Education

Master’s degree or RN license (AZ)

Tools

Word

Excel

Job description

CVS Health is seeking a full-time clinician to coordinate utilization/benefit management services in Arizona. The role requires applying medical necessity criteria, documenting decisions, and collaborating with providers to optimize patient care.

The candidate should have a Master’s degree or an AZ-licensed RN/clinical credential, 2+ years in utilization management, and be able to work 8am-5pm AZ time with occasional weekends. Up to 10% travel to Phoenix, AZ.