Utilization Management Clinician: Care Coordination

CVS Health Corporation; Kansas; Hybrid; USD 36,000 - 103,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision benefits

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program. The role supports child and adolescent members, requires Arizona licensure (RN or related license), and normal hours are Monday–Friday 8am–5pm Arizona Time with occasional weekends.

You will gather clinical information, apply medical necessity criteria, render coverage recommendations, and collaborate with providers to facilitate appropriate care.

Qualifications

• 2+ years of clinical experience in utilization management or related behavioral health setting.
• Active and in good standing Arizona clinical license (RN, LPC, LAC, LMFT, LMAFT, LMSW or LCSW).
• Ability to work Monday–Friday 8am–5pm Arizona Time, with weekend/holiday coverage as needed.
• Willingness to travel up to 10% within Phoenix, AZ.

Responsibilities

• Coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Apply medical necessity criteria and guidelines for child/adolescent member care.
• Consult with internal/external partners to administer utilization activities.
• Gather clinical data to render coverage determinations and referrals as needed.
• Collaborate with providers to facilitate appropriate healthcare services and interventions.

Skills

Clinical utilization management

Behavioral health

Communication skills

Time management

Microsoft Office

Travel readiness

Education

Arizona license: RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW

Tools

Word

Excel

Job description

CVS Health is seeking a clinician to coordinate, document, and communicate all aspects of the utilization/benefit management program. The role supports child and adolescent members, requires Arizona licensure (RN or related license), and normal hours are Monday–Friday 8am–5pm Arizona Time with occasional weekends.

You will gather clinical information, apply medical necessity criteria, render coverage recommendations, and collaborate with providers to facilitate appropriate care.