Utilization Management Clinician

We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience.

At CVS Health, you'll be surrounded by colleagues who care deeply, innovate with purpose, hold themselves accountable, and prioritize safety and quality in everything they do.

Position Summary

As a Utilization Management Clinician, you will utilize clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.

Key responsibilities include:

• Applying critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services for child and adolescent members.
• Consulting and lending expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• Gathering clinical information and applying the appropriate medical necessity criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care.
• Utilizing clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members, including urgent or emergent interventions.
• Coordinating and communicating with providers and other parties to facilitate optimal care/treatment.
• Identifying members who may benefit from care management programs and facilitating referral.
• Identifying opportunities to promote quality effectiveness of healthcare services and benefit utilization.

Sedentary Work This role involves sedentary work with periods of sitting, talking, and listening.

Required Qualifications

• 2+ years of behavioral health experience.
• Active and good standing Arizona clinical and/or counseling license, specifically RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW.
• Willingness to work Monday-Friday from 8am-5pm (Arizona Time), as well as to work occasional weekends and holidays as needed.
• Willingness to travel up to 10% of the time within the United States.

Preferred Qualifications

• Previous experience working within the mental health system.
• Knowledge of behavioral health outpatient services.
• Ability to collaborate with various internal departments.
• Strong communication skills.
• Strong organizational and time management skills.

Education

• Master's-level clinician and/or RN, licensed in the state of Arizona.

Anticipated Weekly Hours 40

Time Type Full-time

Pay Range $26.01 - $74.78

Benefits This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.