Utilization Management Clinical Consultant

CVS Health; New Jersey; Hybride; USD 36 000 - 103 000; Plein temps

Avantages offerts par ce poste

Bonus eligibility

Benefits package

Résumé du poste

CVS Health is seeking a clinician to coordinate and document all aspects of utilization/benefit management. The role applies evidence-based criteria to determine medical necessity and supports care coordination across the continuum.

The position requires 2+ years in behavioral health, an active clinical license in Arizona, and willingness to work standard hours with some travel. A comprehensive benefits package and bonus eligibility are provided.

Qualifications

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

Responsabilités

• Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Applies clinical judgment to render coverage determinations/recommendations along the continuum of care.
• Identifies members who may benefit from care management and facilitates referrals.
• Coordinates with providers to facilitate optimal care and service utilization.

Connaissances

Behavioral health experience

Communication skills

Organization

Time management

Travel flexibility

Formation

Master's degree / RN license

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

• Masters-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.

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.

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 (https://learn.bswift.com/cvshealth-mainland) .

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.

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.