Utilization Management Clinical Consultant

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary

• Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
• Applies 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.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure, and clinical judgment to render
  coverage determination/recommendation/discharge planning along the continuum of care.
• Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members, including urgent or emergent interventions (such as triage/crisis support).
• Coordinates and communicates with providers and other parties to facilitate optimal care/treatment.
• Identifies members who may benefit from care management programs and facilitates referral.
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Sedentary work involving periods of sitting, talking, and listening.

• Active and good standing Arizona clinical and/or counseling license, specifically RN (Registered Nurse), LPC (Licensed Professional Counselor), LAC (Licensed Associate Counselor), LMFT (Licensed Marriage and Family Therapist), LAMFT (Licensed Associate Marriage and Family Therapist), LMSW (Licensed Master Social Worker), or LSCW (Licensed Clinical Social Worker).
• Ability to work Monday-Friday from 8am-5pm (Arizona Time), as well as to work occasional weekends and holidays as needed.
• Ability to travel up to 10% of the time within the United States.

• Previous experience working within the mental health system.
• 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.

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.