Utilization Management Clinical Consultant

CVS Health

. 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 skills and evidence-based care while ensuring compliance with medical necessity criteria. 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 LicenseMaster’s-Level ClinicianUtilization ManagementStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical SkillsCritical ThinkingEvidence-Based CareMedical Necessity CriteriaCoverage DeterminationsDischarge PlanningTriage SupportCare Management ProgramsHealthcare Services EvaluationBenefit Utilization

Soft Skills

Strong Organizational SkillsTime Management SkillsCollaboration Skills

Certifications & Qualifications

Arizona Clinical LicenseRNLPCLACLMFTLMAFTLMSWLCSW

Industry Keywords

Behavioral HealthMental Health SystemOutpatient ServicesCrisis SupportCare Coordination

About the role

Key responsibilities & impact

Coordinate, document, and communicate all aspects of the utilization/benefit management program
Apply clinical skills, critical thinking, evidence-based care, medical necessity criteria, policies, and procedures for child and adolescent members
Consult with internal and external constituents on 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 quality effectiveness of healthcare services and benefit utilization

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
Master’s-level clinician and/or RN, licensed in the state of Arizona
Willingness to work Monday-Friday from 8am-5pm Arizona Time, plus 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

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
CVS Health bonus, commission or short-term incentive program in addition to base pay