Utilization Management Clinical Consultant (Must be licensed in Arizona)

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.

Conduct clinical reviews for adult inpatient behavioral health cases, applying established medical necessity criteria to ensure appropriate levels of care and treatment planning.

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 rendercoverage 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.

Required Qualifications

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), LMAFT (Licensed Associate Marriage and Family Therapist), LMSW (Licensed Master Social Worker), or LCSW (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.

Preferred Qualifications

Previous experience working within the mental health system.

Previous experience with utilization management.

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

The typical pay range for this role is :

$26.01 - $74.78

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include :

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.

For more information, visit

We anticipate the application window for this opening will close on : 11 / 25 / 2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex / gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.