Utilization Management Clinical Consultant

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: coverage determination/recommendation/discharge planning along the continuum of care. - Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. - 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 render - Utilizes...