Remote Behavioral Health Precertification Clinician

CVS Health; California; Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Fully remote

Consistent weekday schedule

Comprehensive benefits

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote, weekday schedule (12:00 PM – 8:30 PM EST). You will review authorization requests, ensure medical necessity, and support levels of care across inpatient mental health, detox, and substance use programs.

Qualified candidates hold an active Behavioral Health license (e.g., LMSW, LCSW, LISW, LPC) or an RN with psychiatric/behavioral health experience, plus 1+ year UM experience and 3+ years inpatient

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in state of residence (e.g., LMSW, LCSW, LISW, LPC) or equivalent independent clinical license.
• Active, unrestricted RN license with psychiatric/behavioral health experience.
• 1+ year Behavioral Health Utilization Review or Utilization Management experience.
• 3+ years inpatient behavioral health experience in a hospital setting.
• Ability to work the scheduled hours 12:00 PM – 8:30 PM EST.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate 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 to providers and internal stakeholders.
• Identify opportunities to improve quality, reduce denials and optimize benefit utilization.

Skills

Utilization Management

Clinical decision making

Behavioral Health assessments

Inpatient behavioral health

Education

Master's degree in Social Work, Counseling, Psychology, or related Behavioral Health discipline

ADN in Nursing with Behavioral Health experience

BSN (preferred)

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote, weekday schedule (12:00 PM – 8:30 PM EST). You will review authorization requests, ensure medical necessity, and support levels of care across inpatient mental health, detox, and substance use programs.

Qualified candidates hold an active Behavioral Health license (e.g., LMSW, LCSW, LISW, LPC) or an RN with psychiatric/behavioral health experience, plus 1+ year UM experience and 3+ years inpatient