Utilization Management Clinical Consultant

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

📋 Description

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

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

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

• Collect clinical data to make coverage decisions, provide recommendations, and assist with discharge planning throughout the care continuum.

• Assess and promote suitable healthcare services and benefits, including urgent or emergency interventions such as triage and crisis support.

• Coordinate and liaise with providers and other parties to ensure optimal care and treatment.

• Identify members who could benefit from care management programs and facilitate necessary referrals.

• Spot opportunities to enhance the quality and effectiveness of healthcare services and benefit utilization.

⛳️ Requirements

• A minimum of 2 years of experience in behavioral health.

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

• Master’s-level clinician and/or RN, licensed in Arizona.

• Availability to work Monday through Friday from 8 am to 5 pm Arizona Time, with occasional weekends and holidays as necessary.

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

• Prior experience within the mental health system is preferred.

• Familiarity with behavioral health outpatient services is preferred.

• Ability to collaborate with various internal departments.

• Excellent communication skills.

• Strong organizational and time management abilities.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.