Utilization Management Clinical Consultant

CVS Health

Clinical Consultant utilizing clinical skills for benefit management at CVS Health. Coordinating care for child and adolescent members through effective communication and documentation.

Posted 5/5/2026full-timeRemote • Arizona • 🇺🇸 United StatesMid-LevelSenior💰 $26 - $75 per hourWebsite

About the role

Key responsibilities & impact

Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.
Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence-based standards and practice guidelines to treatment where appropriate.
Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage.
Coordinates with providers and other parties to facilitate optimal care/treatment.
Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.
Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.

Requirements

What you’ll need

Must reside in Kentucky or bordering state Counties
Licensed independent behavioral health clinician with Kentucky state licensure (LCSW, LPCC, LMFT, LPAT) or a Registered Nurse (RN) with active current and unrestricted Kentucky state license with psychiatric specialty, or behavioral health experience or certification
3+ years clinical practice experience in behavioral health, e.g., hospital setting, residential setting, or outpatient behavioral health setting
Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
Willing and able to work Monday through Friday, 8am - 5pm EST with some flexibility to work outside of the standard schedule based on business needs

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical practice guidelinesevidence-based caretreatment planningclinical assessmentutilization managementclinical documentationhealthcare services coordinationbehavioral health experiencepsychiatric specialtymultitasking

Soft Skills

critical thinkingcollaborationcommunicationadaptabilityprioritizationproblem-solvingquality improvementconsultationevaluationcoordination

Certifications

LCSWLPCCLMFTLPATRegistered Nurse (RN)