Utilization Management Clinical Consultant

Job not on LinkedIn

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🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $26 - $74 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

💼 Consultant

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Coordinate, document, and communicate all aspects of the utilization/benefit management program • Apply critical thinking, clinical knowledge, evidence-based care, and medical necessity criteria to determine appropriate utilization of services for child and adolescent members • Consult with internal and external constituents regarding coordination and administration of utilization/benefit management • Gather clinical information and apply medical necessity criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations, recommendations, and discharge planning • 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 quality and effectiveness of healthcare services and benefit utilization • Perform sedentary work involving periods of sitting, talking, and listening

🎯 Requirements

• 2+ years of clinical experience in a behavioral health setting working directly with utilization management • Active and good standing Arizona clinical and/or counseling license: RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW • Ability to work Monday-Friday from 8am-5pm Arizona Time, plus occasional weekends and holidays as needed • Ability to travel up to 10% of the time within Phoenix, AZ • Preferred: 3+ years of behavioral health clinical practice experience in a hospital, outpatient clinic, or residential facility • Preferred: 3+ years of experience documenting electronically using keyboards and multiple computer screens, navigating internal/external computer systems, and using Microsoft Office Suite, including Word and Excel • 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 range • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being