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Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position Summary

This is a full-time telework role, but may require occasional travel to the Phoenix, AZ area for meetings. Working schedule is Monday-Friday 8am - 5pm. Occasional requirement for coverage during holidays and weekends through rotation.Mercy Care is a not-for-profit Medicaid managed-care health plan, serving Arizonans since 1985. We provide access to physical and behavioral health care services, to people who are eligible for Medicaid. Our members include families, children, seniors, and individuals who have developmental/cognitive disabilities. We hold multiple contracts with AHCCCS, Arizona's Medicaid agency, and deliver services throughout the state.

• 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 Adult, Child and Adolescents 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 coverage determination/recommendation/discharge planning along the continuum of care
• Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)
• Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
• Identifies members who may benefit from care management programs and facilitates referral
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
• Sedentary work involving periods of sitting, talking, listening

• Must have a Behavioral Health license in the state of Arizona: Independent Licensed as: Clinical Social Worker (LCSW), Professional Counselor (LPC), Marriage and Family Therapist (LMFT), LAC, LAMFT, or LMSW OR RN with unrestricted Arizona state license or compact RN license with Behavioral Health Experience
• 2+ years behavioral health clinical practice experience in a hospital, outpatient clinic, or residential facility setting
• Working schedule is Monday-Friday 8:00am - 5:00pm AZ time zone. Occasional requirement for coverage during holidays and weekends through rotation.

• Understanding or working knowledge of the Arizona Medicaid system
• Utilization review experience
• Managed Care experience
• Experience documenting electronically using keyboard and multiple computer screens - navigating through internal/external computer systems, and MS Office suite including Word and Excel

• For BH License: Minimum of a Master's degree in Behavioral health or related field
• For RN License: Minimum of an Associate's degree in Nursing required