Clinical Utilization Strategist

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health Corporation in the United States seeks a licensed clinician to coordinate, document, and communicate all aspects of utilization/benefit management for pediatric and adult members. You will apply criteria for medical necessity and collaborate with providers to ensure appropriate care.

The role requires 2+ years in a clinical/behavioral health setting, an active Arizona license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW), and a 40-hour workweek (Mon-Fri 8am-5pm AZ time) with some travel within

Qualifications

• 2+ years of clinical, behavioral health experience in utilization management.
• 2+ years of experience in clinical, behavioral health setting, working directly with utilization management.
• Active Arizona licensure (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW) in good standing.

Responsibilities

• Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Applies critical thinking and medical necessity criteria for appropriate utilization of services for child and adolescent members.
• Consults and lends expertise to other internal/external constituents in utilization/benefit management.

Skills

Clinical experience

Communication skills

Organizational skills

Time management

Education

Master’s-level clinician and/or RN

Licensed in Arizona

Tools

Microsoft Word

Microsoft Excel

Job description

CVS Health Corporation in the United States seeks a licensed clinician to coordinate, document, and communicate all aspects of utilization/benefit management for pediatric and adult members. You will apply criteria for medical necessity and collaborate with providers to ensure appropriate care.

The role requires 2+ years in a clinical/behavioral health setting, an active Arizona license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW), and a 40-hour workweek (Mon-Fri 8am-5pm AZ time) with some travel within