Utilization Management Clinical Consultant

CVS Health

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

Posted 9/21/2026full-timeRemote • Arizona • United StatesJuniorMid-Level💰 $26 - $75 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in utilization management and clinical assessment within behavioral health, applying medical necessity criteria and evidence-based care to optimize service delivery. Proficient in coordinating care, facilitating referrals, and enhancing the quality of healthcare services.

Highest-signal resume keywords

Utilization ManagementClinical Experience in Behavioral HealthArizona Clinical License (RN, LPC, LAC, LMFT, LMAFT, LMSW, LCSW)Electronic Documentation SkillsStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Necessity CriteriaEvidence-Based CareClinical JudgmentTriage/Crisis SupportCare Management Programs

Soft Skills

Organizational SkillsTime Management SkillsCollaboration Skills

Tools & Technologies

Microsoft Office SuiteElectronic Health Records

Certifications & Qualifications

Arizona Clinical License

Industry Keywords

Behavioral HealthUtilization/Benefit ManagementHealthcare ServicesDischarge Planning

About the role

Key responsibilities & impact

Coordinate, document, and communicate all aspects of the utilization/benefit management program
Apply critical thinking, clinical knowledge, evidence-based care, and medical necessity criteria to determine appropriate utilization of services for child and adolescent members
Consult with internal and external constituents regarding coordination and administration of utilization/benefit management
Gather clinical information and apply medical necessity criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations, recommendations, and discharge planning
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 and effectiveness of healthcare services and benefit utilization
Perform sedentary work involving periods of sitting, talking, and listening

Requirements

What you’ll need

2+ years of clinical experience in a behavioral health setting working directly with utilization management
Active and good standing Arizona clinical and/or counseling license: RN, LPC, LAC, LMFT, LMAFT, LMSW, or LCSW
Ability to work Monday-Friday from 8am-5pm Arizona Time, plus occasional weekends and holidays as needed
Ability to travel up to 10% of the time within Phoenix, AZ
Preferred: 3+ years of behavioral health clinical practice experience in a hospital, outpatient clinic, or residential facility
Preferred: 3+ years of experience documenting electronically using keyboards and multiple computer screens, navigating internal/external computer systems, and using Microsoft Office Suite, including Word and Excel
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 range
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being