Utilization Management Clinician: Care Coordination & Benefits

CVS Health Corporation; Arkansas; Hybrid; USD 3,596,000 - 10,302,000; Full time

Job summary

CVS Health Corporation seeks a clinically skilled professional to coordinate and document utilization/benefit management activities. You will apply medical necessity criteria and collaborate with providers and internal teams to render coverage decisions and discharge planning.

The role requires 2+ years in behavioral health utilization management, an Arizona clinical license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW), and availability to work 8am–5pm Arizona time with potential weekends and up to 10%

Qualifications

• 2+ years of clinical, behavioral health setting experience in utilization management.
• Active and good standing Arizona clinical license (RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW).
• Ability to work 8am-5pm Arizona Time, with occasional weekends/holidays and up to 10% travel.

Responsibilities

• Coordinate, document, and communicate utilization/benefit management activities.
• Apply medical necessity criteria and policy to determine coverage decisions.
• Lend expertise to internal and external stakeholders in utilization management.

Skills

Utilization management

Clinical communication

Cross-functional collaboration

Education

Master's-level clinician or RN

Tools

Microsoft Word

Excel

Job description

CVS Health Corporation seeks a clinically skilled professional to coordinate and document utilization/benefit management activities. You will apply medical necessity criteria and collaborate with providers and internal teams to render coverage decisions and discharge planning.

The role requires 2+ years in behavioral health utilization management, an Arizona clinical license (RN/LPC/LAC/LMFT/LMAFT/LMSW/LCSW), and availability to work 8am–5pm Arizona time with potential weekends and up to 10%