Utilization Management Clinician — Care Coordination Expert

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

Benefits offered by this job

Bonus eligibility

Comprehensive benefits package

Job summary

CVS Health Corporation seeks an experienced clinician to coordinate utilization management and documentation across the care continuum. You will apply medical necessity criteria, collaborate with providers, and determine coverage decisions while supporting urgent interventions when needed.

Requirements include 2+ years in behavioral health utilization, an AZ license (RN or equivalent), and ability to travel up to 10% in the Phoenix area; the role is full-time with a strong benefits package.

Qualifications

• 2+ years of clinical, behavioral health experience in utilization management.
• Active and good standing license: RN or licensed behavioral health professional in AZ.
• Ability to work 8am-5pm AZ time, Monday-Friday, with some weekends/holidays.
• Travel up to 10% within Phoenix, AZ.

Responsibilities

• Coordinate, document, and communicate utilization/benefit management activities.
• Apply medical necessity criteria for appropriate service utilization.
• Consult with internal/external stakeholders in utilization management.
• Gather clinical data and render coverage determinations and referrals.
• Evaluate services to ensure quality care and urgent interventions when needed.
• Coordinate with providers to facilitate optimal care and treatment.
• Identify members for care management referrals.
• Promote quality and effective benefit utilization.

Skills

Utilization management

Clinical/behavioral health experience

Communication skills

Microsoft Word / Excel

Education

Master’s-level clinician or RN

Tools

Microsoft Word

Microsoft Excel

Job description

CVS Health Corporation seeks an experienced clinician to coordinate utilization management and documentation across the care continuum. You will apply medical necessity criteria, collaborate with providers, and determine coverage decisions while supporting urgent interventions when needed.

Requirements include 2+ years in behavioral health utilization, an AZ license (RN or equivalent), and ability to travel up to 10% in the Phoenix area; the role is full-time with a strong benefits package.