Utilization Management Clinical Consultant

Job not on LinkedIn

🔥 1 hour ago

🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $26 - $74 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

👻 Ghost score 0%

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Coordinate, document, and communicate all aspects of the utilization/benefit management program • Apply critical thinking, evidence-based care, medical necessity criteria, policies, procedures, and clinical judgment for child and adolescent members • Consult with internal and external constituents regarding utilization/benefit management • Gather clinical information and render coverage determinations, recommendations, and discharge planning across the continuum of care • Evaluate and facilitate appropriate healthcare services and benefits, including urgent or emergent interventions such as triage/crisis support • Coordinate and communicate with providers and other parties to facilitate optimal care and treatment • Identify members who may benefit from care management programs and facilitate referrals • Identify opportunities to promote healthcare service quality and effective benefit utilization • Perform sedentary work involving periods of sitting, talking, and listening

🎯 Requirements

• 2+ years of behavioral health experience • Active and good standing Arizona clinical and/or counseling license: RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW • Willingness to work Monday-Friday from 8am-5pm Arizona Time • Willingness to work occasional weekends and holidays as needed • Willingness to travel up to 10% of the time within the United States • Previous experience working within the mental health system preferred • Knowledge of behavioral health outpatient services preferred • Ability to collaborate with various internal departments • Strong communication skills • Strong organizational and time management skills • Master’s-level clinician and/or RN, licensed in the state of Arizona

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being

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