Utilization Management Clinical Consultant

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Oversee, document, and relay all elements of the utilization and benefit management program.

• Utilize critical thinking, evidence-based care, medical necessity criteria, policies, procedures, and clinical judgment for child and adolescent members.

• Consult with both internal and external stakeholders regarding utilization and benefit management.

• Collect clinical information to make coverage determinations, recommendations, and discharge planning throughout the continuum of care.

• Assess and facilitate suitable healthcare services and benefits, including urgent or emergent interventions like triage and crisis support.

• Coordinate and communicate with providers and other entities to ensure optimal care and treatment.

• Identify members who could gain from care management programs and assist with referrals.

• Spot opportunities to enhance healthcare service quality and effective benefit utilization.

• Engage in sedentary work that includes sitting, talking, and listening for extended periods.

⛳️ Requirements

• Minimum of 2 years of experience in behavioral health.

• Active and in good standing Arizona clinical and/or counseling license: RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW.

• Availability to work Monday through Friday from 8 AM to 5 PM Arizona Time.

• Willingness to work occasional weekends and holidays as required.

• Ability to travel up to 10% of the time within the United States.

• Previous experience within the mental health system is preferred.

• Familiarity with behavioral health outpatient services is a plus.

• Capability to collaborate effectively with various internal departments.

• Excellent communication skills.

• Strong organizational and time management abilities.

• 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.

• Additional resources to support physical, emotional, and financial well-being.