Clinical Utilization Strategist - Care Coordination

4004 Aetna Medicaid Administrators; Arizona; Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical insurance

Dental and vision coverage

Paid time off

Retirement savings plan

Wellness programs

Job summary

CVS Health is seeking a qualified clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program for child and adolescent members. You will apply medical necessity criteria and collaborate with providers to ensure appropriate care across the continuum.

The role requires 2+ years in clinical/behavioral health utilization management, an Arizona license, and the ability to work 8am–5pm AZ time with occasional weekends/holidays.

Qualifications

• Active Arizona clinical/counseling license required.
• 2+ years in clinical/behavioral health utilization management.
• Ability to work 8am–5pm Arizona time with possible weekends/holidays.

Responsibilities

• Coordinate utilization/benefit management activities.
• Document and communicate care coordination and medical necessity decisions.
• Collaborate with providers and internal/external stakeholders to optimize care.
• Identify members who may benefit from care management and refer accordingly.

Skills

Clinical assessment

Utilization management

Communication skills

Time management

Education

Arizona licensed clinician

Tools

MS Office

Excel

Word

Job description

CVS Health is seeking a qualified clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program for child and adolescent members. You will apply medical necessity criteria and collaborate with providers to ensure appropriate care across the continuum.

The role requires 2+ years in clinical/behavioral health utilization management, an Arizona license, and the ability to work 8am–5pm AZ time with occasional weekends/holidays.