Utilization Management Clinical Consultant

CVS Health Careers

. Coordinate, document, and communicate all aspects of the utilization/benefit management program .

Posted 11/11/2026full-timeRemote • Arizona • United StatesJuniorMid-Level💰 $26 - $75 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in utilization and benefit management for child and adolescent members, applying clinical judgment and evidence-based care. Strong ability to collaborate with healthcare providers and facilitate optimal care through effective communication and organizational skills.

Highest-signal resume keywords

Behavioral Health ExperienceArizona Clinical LicenseEvidence-Based CareCommunication SkillsOrganizational Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ManagementClinical JudgmentCoverage DeterminationsDischarge PlanningTriage SupportCare ManagementBehavioral Health Outpatient Services

Soft Skills

Critical ThinkingCollaborationTime Management

Certifications & Qualifications

Arizona RN LicenseLPC LicenseLAC LicenseLMFT LicenseLMAFT LicenseLMSW LicenseLCSW License

Industry Keywords

Mental Health SystemHealthcare ServicesCrisis SupportBenefit Utilization

About the role

Key responsibilities & impact

Coordinate, document, and communicate all aspects of the utilization/benefit management program
Apply critical thinking, evidence-based care, medical necessity criteria, policies, procedures, and clinical judgment for child and adolescent members
Consult with internal and external constituents regarding utilization/benefit management
Gather clinical information and render coverage determinations, recommendations, and discharge planning across the continuum of care
Evaluate and facilitate appropriate healthcare services and benefits, including urgent or emergent interventions such as triage/crisis support
Coordinate and communicate with providers and other parties to facilitate optimal care and treatment
Identify members who may benefit from care management programs and facilitate referrals
Identify opportunities to promote healthcare service quality and effective benefit utilization
Perform sedentary work involving periods of sitting, talking, and listening

Requirements

What you’ll need

2+ years of behavioral health experience
Active and good standing Arizona clinical and/or counseling license: RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW
Willingness to work Monday-Friday from 8am-5pm Arizona Time
Willingness to work occasional weekends and holidays as needed
Willingness to travel up to 10% of the time within the United States
Previous experience working within the mental health system preferred
Knowledge of behavioral health outpatient services preferred
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

Benefits

Comp & perks

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
Other resources supporting physical, emotional, and financial well-being