Remote Behavioral Health Precertification Clinician

CVS Health; California City (CA); Remote; USD 54,000 - 117,000; Full time

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role. You will review authorization requests, evaluate medical necessity, and ensure appropriate levels of care for inpatient mental health, detoxification, and substance use programs.

The position requires an active behavioral health license (or an RN with psychiatric experience) and 1+ year UM experience, plus 3+ years inpatient BH in a hospital setting. Hours are 12:00 PM–8:30 PM EST, Monday–Friday.

Qualifications

• Licensed Behavioral Health professional with applicable state license (e.g., LMSW, LCSW, LISW, LPC)
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience
• 3+ years of inpatient behavioral health in a hospital setting

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity
• Apply evidence-based behavioral health guidelines to authorization decisions
• Coordinate with facilities to obtain additional clinical information
• Support discharge planning and transitions of care
• Communicate authorization decisions to providers and internal stakeholders
• Identify opportunities to improve quality and reduce denials

Skills

BH UM experience

Clinical judgment

Cross-functional collaboration

Education

Master's degree in Behavioral Health fields

Associate Degree in Nursing (ADN)

Bachelor of Science in Nursing (BSN)

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role. You will review authorization requests, evaluate medical necessity, and ensure appropriate levels of care for inpatient mental health, detoxification, and substance use programs.

The position requires an active behavioral health license (or an RN with psychiatric experience) and 1+ year UM experience, plus 3+ years inpatient BH in a hospital setting. Hours are 12:00 PM–8:30 PM EST, Monday–Friday.