Utilization Management Clinical Consultant

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

📋 Description

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

• Utilize critical thinking, clinical expertise, evidence-based care, and medical necessity standards to assess proper service utilization for child and adolescent members.

• Collaborate with both internal and external stakeholders concerning the coordination and administration of utilization and benefit management.

• Collect clinical information and implement medical necessity criteria, guidelines, policies, procedures, and clinical judgment to make coverage determinations, recommendations, and discharge plans.

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

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

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

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

• Engage in sedentary work involving extended periods of sitting, talking, and listening.

⛳️ Requirements

• A minimum of 2 years of clinical experience in a behavioral health environment with direct involvement in utilization management.

• An active and valid 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, with occasional weekend and holiday work as required.

• Willingness to travel up to 10% of the time within Phoenix, AZ.

• Preferred: At least 3 years of clinical practice experience in behavioral health within a hospital, outpatient clinic, or residential facility.

• Preferred: A minimum of 3 years of experience with electronic documentation using keyboards and multiple computer screens, navigating both internal and external computer systems, and proficiency in Microsoft Office Suite, including Word and Excel.

• Ability to work collaboratively 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 the base pay range.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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