Utilization Management Clinical Consultant

4004 Aetna Medicaid Administrators; Arizona; Hybride; USD 36 000 - 103 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Résumé du poste

CVS Health in Arizona is seeking a licensed clinician to coordinate utilization/benefit management services for child and adolescent members. You will review medical necessity, document decisions, and collaborate with providers to ensure appropriate care.

The role emphasizes evidence-based practice, clinical judgment, and timely communication, with standard 40-hour work week and occasional travel within the United States.

Qualifications

• 2+ years of behavioral health experience.
• Active and good standing Arizona clinical and/or counseling license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW).
• Willingness to work Monday-Friday from 8am-5pm (Arizona Time), with occasional weekends/holidays.
• Willingness to travel up to 10% within the United States.

Responsabilités

• Coordinate, document, and communicate all aspects of utilization/benefit management.
• Consult and lend expertise to internal and external constituents in coordination of utilization activities.
• Gather clinical information and apply medical necessity criteria to render coverage determinations.
• Coordinate with providers to facilitate optimal care and referrals as needed.

Connaissances

Behavioral health experience

Communication skills

Time management

Organizational skills

Formation

Master’s-level clinician or RN

Description du poste

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services for child and adolescent members. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care. Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members, including urgent or emergent interventions (such as triage/crisis support). Coordinates and communicates with providers and other parties to facilitate optimal care/treatment. Identifies members who may benefit from care management programs and facilitates referral. Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization. Sedentary work involving periods of sitting, talking, and listening.

Required Qualifications

• 2+ years of behavioral health experience.
• Active and good standing Arizona clinical and/or counseling license, specifically RN (Registered Nurse), LPC (Licensed Professional Counselor), LAC (Licensed Associate Counselor), LMFT (Licensed Marriage and Family Therapist), LMAFT (Licensed Associate Marriage and Family Therapist), LMSW (Licensed Master Social Worker), or LCSW (Licensed Clinical Social Worker).
• Willingness to work Monday-Friday from 8am-5pm (Arizona Time), as well as to work occasional weekends and holidays as needed.
• Willingness to travel up to 10% of the time within the United States.

Preferred Qualifications

• Previous experience working within the mental health system.
• Knowledge of behavioral health outpatient services.
• Ability to collaborate with various internal departments.
• Strong communication skills.
• Strong organizational and time management skills.

Education

Master’s-level clinician and/or RN, licensed in the state of Arizona.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $26.01 - $74.78

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Benefits

Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

Application Window

We anticipate the application window for this opening will close on: 11/27/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Company Culture

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people.

Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.