Utilization Management Clinical Consultant

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

Avantages offerts par ce poste

Bonus eligibility

Medical, dental, vision coverage

Paid time off

Résumé du poste

CVS Health is seeking a qualified behavioral health professional to coordinate utilization/benefit management for child and adolescent members. The role emphasizes evidence-based care, clinical judgment, and collaboration with providers to ensure appropriate coverage determinations and discharge planning.

You will work a Monday–Friday schedule in Arizona time, with occasional weekend/holiday coverage and up to 10% travel across the United States.

Qualifications

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

Responsabilités

• Coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Apply clinical judgement and criteria for medical necessity for appropriate utilization of services.
• Consult with internal and external stakeholders in managing utilization/benefit operations.
• Identify members who may benefit from care management and facilitate referrals.
• Collaborate with providers to coordinate care and promote quality outcomes.

Connaissances

Behavioral health experience

Communication skills

Organizational skills

Time management

Collaborative approach

Formation

Masters-level clinician

RN license (AZ)

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.