Remote Behavioral Health Precertification Clinician

CVS Health; Arkansas City (KS); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Remote work

Weekday schedule

Competitive benefits

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role with a consistent weekday schedule. You will review behavioral health authorizations, assess medical necessity, and determine appropriate levels of care for inpatient, detox, and rehabilitation services.

The role requires a Master’s-level Behavioral Health license or an RN with psychiatric/behavioral health experience, plus 1+ year of utilization management and 3+ years inpatient behavioral health

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in state of residence (e.g., LMSW, LCSW, LISW, LPC, or equivalent).
• Active, unrestricted RN license with psychiatric/behavioral health experience.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and levels of care.
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions.
• Coordinate with facilities and providers to obtain additional clinical information as needed.
• Support discharge planning and transitions of care; communicate decisions and next steps to providers.
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization.

Skills

UM review

Medical necessity

Clinical decision-making

Crisis queue handling

Education

Master's Behavioral Health license (LMSW/LCSW/LISW/LPC or equivalent)

RN license with psych/behavioral health experience

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role with a consistent weekday schedule. You will review behavioral health authorizations, assess medical necessity, and determine appropriate levels of care for inpatient, detox, and rehabilitation services.

The role requires a Master’s-level Behavioral Health license or an RN with psychiatric/behavioral health experience, plus 1+ year of utilization management and 3+ years inpatient behavioral health