Clinical Utilization Specialist

2 weeks ago


Denver, Colorado, United States CVS Health Full time
Job Summary

CVS Health is seeking a skilled Clinical Utilization Specialist to join our team. As a key member of our healthcare team, you will play a critical role in assessing the appropriateness of treatment plans and ensuring that our members receive the best possible care.

Key Responsibilities
  • Utilize clinical expertise to assess treatment plans and apply evidence-based standards and guidelines.
  • Coordinate and monitor healthcare services and benefits for members.
  • Provide triage and crisis support to members in need.
  • Collaborate with healthcare providers to facilitate optimal care and treatment.
  • Identify members at risk for poor outcomes and facilitate referral opportunities.
  • Consult with internal and external constituents to coordinate and administer utilization management functions.
Requirements
  • 3+ years of direct clinical practice experience post-masters degree.
  • Unencumbered independent behavioral health clinical license in the state where you work.
  • Knowledge of mental health and substance abuse disorders.
  • Managed care/utilization review experience.
  • Crisis intervention skills.
What We Offer

CVS Health offers a comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, and employee stock purchase plan. We also offer paid time off, paid holidays, and a fully-paid term life insurance plan.



  • Denver, Colorado, United States Acadia Healthcare Full time

    Job Title: Utilization SpecialistWe are seeking a highly skilled Utilization Specialist to join our team at West Pines Behavioral Hospital, a new 144-bed inpatient behavioral health facility serving the Denver area. As a Utilization Specialist, you will play a critical role in optimizing reimbursement for the facility by proactively monitoring patient...


  • Denver, Colorado, United States Spectrum Healthcare Resources Full time

    Job Title: RN Utilization Management SpecialistSpectrum Healthcare Resources is seeking a highly skilled RN Utilization Management Specialist to join our team. As a key member of our team, you will play a critical role in reviewing cases, educating patients, and managing healthcare costs for the dependents of our Nation's Active Duty and eligible...


  • Denver, Colorado, United States Spectrum Healthcare Resources Full time

    Job Title: RN Utilization Management SpecialistSpectrum Healthcare Resources is seeking a highly organized and self-directed Registered Nurse Utilization Management Specialist to join our team. As a key member of our team, you will be responsible for reviewing cases, educating patients on appropriate care, and managing healthcare costs for the dependents of...

  • Clinical Pharmacist

    5 days ago


    Denver, Colorado, United States UnitedHealth Group Full time

    Job SummaryWe are seeking a highly skilled Clinical Pharmacist to join our team in Utilization Management. As a key member of our team, you will be responsible for ensuring the effective management of medication utilization and prior authorization requests for value-based patients in the Optum West region.Key ResponsibilitiesCollaborate with the Pharmacy and...


  • Denver, Colorado, United States Joulé Full time

    Job Title: Clinical Applications SpecialistAt Joulé, we are seeking a highly skilled Clinical Applications Specialist to provide technical support for our healthcare clients. This is a six-month contract position with potential for extension.The ideal candidate will have prior experience in healthcare, supporting web-based applications and providing EMR...


  • Denver, Colorado, United States destinationone Consulting Full time

    Job Title: Drug Utilization Review SpecialistAt destinationone Consulting, we are seeking a highly skilled Drug Utilization Review Specialist to join our team. As a key member of our healthcare recruitment team, you will play a critical role in evaluating medication use patterns to promote safe and effective medication therapy.Key Responsibilities:Conduct...


  • Denver, Colorado, United States Pro-Vac Full time

    As a Utility Location Specialist with Pro-Vac, you will be responsible for delivering top-tier service to our customers through safe, efficient, and innovative subsurface solutions. You will travel locally and long-distance to deliver exceptional results, utilizing your expertise in engineering locating to ensure the maintenance and construction of critical...

  • Clinical Specialist

    3 weeks ago


    Denver, Colorado, United States Vektor Medical, Inc. Full time

    Clinical Specialist Job DescriptionVektor Medical, Inc. is seeking a highly skilled Clinical Specialist to join our team. As a Clinical Specialist, you will play a critical role in providing clinical customer support, training, and onboarding new sites, while maintaining a strong rapport with site Electrophysiologists, lab staff, and administration.Key...


  • Denver, Colorado, United States Destinationone Consulting Full time

    Job DescriptionDestinationone Consulting specializes in recruitment across diverse sectors, including Healthcare, Health Tech, Government, Municipalities, Non-Profits, Legal, Public Accounting, Food and more. We are proactively building a data bank for opportunities in these fields. By applying, you ensure our recruiters can quickly match you with suitable...

  • Clinical Specialist

    4 days ago


    Denver, Colorado, United States Vektor Medical, Inc. Full time

    Clinical SpecialistVektor Medical, Inc. is seeking a highly skilled Clinical Specialist to join our team. As a key member of our commercialization efforts, you will play a critical role in the development, maintenance, and management of our mapping solution, clinical, and research efforts.Key Responsibilities:Provide exceptional clinical customer support...


  • Denver, Colorado, United States Intermountain Health Full time

    Job Summary:The Clinical Nurse Specialist (CNS) is a registered nurse with advanced education and training in a specific clinical area. The CNS assumes responsibility and accountability for assessing, planning, implementing, and evaluating care of patients in the Emergency Department (ED).Key Responsibilities: Assess patients' psychological and physical...

  • Clinical Specialist I

    3 weeks ago


    Denver, Colorado, United States myGwork Full time

    Join Boston Scientific as a Clinical Specialist IWe are seeking a highly motivated and experienced Clinical Specialist I to join our team at Boston Scientific. As a Clinical Specialist I, you will be responsible for providing clinical support to our customers, including product training, troubleshooting, and technical assistance.Key Responsibilities:Provide...

  • Clinical Specialist

    4 weeks ago


    Denver, Colorado, United States Indivior PLC Full time

    Job Title: Clinical SpecialistIndivior PLC is seeking a highly motivated and experienced Clinical Specialist to join our team. As a Clinical Specialist, you will be responsible for calling on practicing physicians, hospitals, clinics, and other health-related organizations within an assigned territory.Key Responsibilities:Provide healthcare professionals...


  • Denver, Colorado, United States destinationone Consulting Full time

    Destinationone Consulting: Clinical Nurse Specialist OpportunityWe are seeking a highly skilled Clinical Nurse Specialist to join our team at destinationone Consulting. As a Clinical Nurse Specialist, you will play a critical role in enhancing patient care, guiding nursing practices, and improving healthcare outcomes through evidence-based strategies.Key...


  • Denver, Colorado, United States Eurofins USA Clinical Diagnostics Full time

    Job Summary:We are seeking a skilled Microbiological Laboratory Specialist to join our team at Eurofins USA Clinical Diagnostics. As a key member of our laboratory team, you will be responsible for performing microbiological setups, readings, and identifications, as well as providing miscellaneous support activities.Responsibilities:Perform microbiological...


  • Denver, Colorado, United States destinationone Consulting Full time

    Job Overviewdestinationone Consulting is a leading recruitment agency specializing in diverse sectors, including Healthcare, Health Tech, Government, Municipalities, Non-Profits, Legal, Public Accounting, and Food. We are building a comprehensive database of opportunities in these fields.The Drug Utilization Review Specialist plays a crucial role in ensuring...


  • Denver, Colorado, United States Boston Scientific Full time

    Job SummaryBoston Scientific is seeking a highly skilled Clinical Specialist RVT to join our team. As a Clinical Specialist RVT, you will be responsible for promoting commercially approved company products through procedure coverage, proper patient selection, and procedure follow-up. You will also provide clinical education and support to customers, and may...


  • Denver, Colorado, United States Boston Scientific Full time

    Job SummaryWe are seeking a highly skilled Clinical Specialist RVT to join our team at Boston Scientific. As a Clinical Specialist RVT, you will be responsible for promoting commercially approved company products through procedure coverage, proper patient selection, and procedure follow-up. You will also provide clinical education and support to customers,...

  • Safety Specialist

    2 months ago


    Denver, Colorado, United States Primoris Full time

    Primoris, a leading provider of infrastructure solutions, seeks a dedicated Safety Specialist to contribute to our commitment to operational excellence and safety within the Utilities sector. As an integral member of our regional HSE Teams, you will play a vital role in fostering a robust safety culture across assigned operating regions. Your...


  • Denver, Colorado, United States Boston Scientific Full time

    Job SummaryBoston Scientific is seeking a highly skilled Clinical Specialist RVT to join our team. As a Clinical Specialist RVT, you will be responsible for promoting commercially approved company products through procedure coverage, proper patient selection, and procedure follow-up. You will also provide clinical education and support, and may support...