Utilization Management Clinical Consultant

CVS Health Corporation; Washington (District of Columbia); Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Bonus program

Paid time off

Job summary

CVS Health Corporation is seeking a licensed clinician to coordinate, document, and communicate utilization management across the continuum of care. You will apply evidence-based criteria to inform coverage decisions, consult with internal and external stakeholders, and facilitate appropriate healthcare services for members.

Travel to Phoenix area may be required. Ideal candidates have 2+ years in utilization management, Arizona licensure, and strong office-based technical skills.

Qualifications

• 2+ years of clinical experience in utilization management.
• Arizona license: RN, LPC, LAC, LMFT, LMAFT, LMSW or LCSW in good standing.
• Availability to work 8am-5pm Arizona Time, Monday–Friday, with weekends/holidays as needed.
• Travel up to 10% within Phoenix, AZ.

Responsibilities

• Coordinate, document, and communicate utilization management activities.
• Apply medical necessity criteria and guidelines for coverage decisions.
• Consult with internal/external stakeholders to optimize care.
• Gather clinical information to render determinations and referrals.
• Collaborate with providers to facilitate appropriate care/treatment.
• Identify members who may benefit from care management programs.

Skills

Utilization management

Clinical coordination

Patient communication

Microsoft Office

Multitasking

Education

Master's degree in clinical field

Arizona RN license

Tools

Electronic health records (EHR)

Microsoft Office

Word

Excel

Job description

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 experience of clinical, behavioral health setting, working directly with utilization management.
• 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).
• Ability to work Monday-Friday from 8am-5pm (Arizona Time), as well as to work occasional weekends and holidays as needed.
• Ability to travel up to 10% of the time within Phoenix, AZ.

Preferred Qualifications

• 3+ years of behavioral health clinical practice experience in a hospital, outpatient clinic. or residential facility setting.
• 3+ years of experience with documenting, electronically using keyboard and multiple computer screens, navigating through internal/external computer systems, and Microsoft Office Suite applications, including Word and Excel
• 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.

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.

We anticipate the application window for this opening will close on: 10/05/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.