Strategic Clinical Utilization Consultant

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

Job summary

CVS Health is seeking a full‑time clinician to coordinate and document utilization management activities. You will apply clinical criteria to determine medical necessity, render coverage determinations, and collaborate with providers to enable optimal patient care across the continuum.

The role requires AZ licensure and experience in behavioral health utilization management. The position attends to coordination with internal teams, supports care management referrals, and participates in ensuring

Qualifications

• 2+ years of clinical experience in utilization management or related field.
• Active and in-good-standing Arizona clinical license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW).
• Ability to work 8am–5pm Arizona Time, Mon–Fri, with some weekends/holidays as needed.

Responsibilities

• Coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Apply evidence-based criteria to determine medical necessity and plan care pathways.
• Lend expertise to internal/external stakeholders in utilization/benefit management.
• Gather clinical information and render coverage determinations and discharge planning.
• Collaborate with providers to facilitate optimal care/treatment.

Skills

utilization management

clinical experience

communication

Education

Master’s-level clinician or RN license (AZ)

Tools

Word

Excel

Job description

CVS Health is seeking a full‑time clinician to coordinate and document utilization management activities. You will apply clinical criteria to determine medical necessity, render coverage determinations, and collaborate with providers to enable optimal patient care across the continuum.

The role requires AZ licensure and experience in behavioral health utilization management. The position attends to coordination with internal teams, supports care management referrals, and participates in ensuring