Remote Behavioral Health Precertification Clinician

CVS Health; Central City (CO); A distancia; USD 54.000 - 117.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Fully remote

Comprehensive benefits

Bonus eligibility

Descripción de la vacante

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role. You will review behavioral health authorizations, determine medical necessity, and ensure appropriate levels of care for inpatient mental health, detox, and substance-use rehab.

The ideal candidate is a licensed behavioral health professional or psychiatric RN with Utilization Management experience, able to work 12:00 PM–8:30 PM EST, Monday–Friday, and collaborate with providers and facilities to

Formación

• Active, unrestricted Master's-level Behavioral Health license in the state of residence, such as LMSW, LCSW, LISW, LPC, or equivalent.
• Active, unrestricted Registered Nurse (RN) license with psychiatric/behavioral health experience.
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience.
• 3+ years of inpatient behavioral health experience in a hospital setting.
• Ability to work the scheduled hours of 12:00 PM – 8:30 PM EST.
• Strong clinical decision-making and medical necessity review skills.

Responsabilidades

• Review behavioral health authorization requests and clinical documentation to determine medical necessity.
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions.
• Utilize Medicare coverage criteria and requirements when applicable.
• Document determinations, rationale, and recommendations accurately and thoroughly.
• Coordinate with facilities and providers to obtain additional clinical information when needed.
• Support discharge planning and transitions of care.
• Communicate authorization decisions and next steps to providers and internal stakeholders.
• Identify members who may benefit from additional clinical programs and care management.
• Participate in crisis queue coverage, including triage, call handling, escalation, and documentation.

Conocimientos

Clinical decision making

Medical necessity review

Documentation

Communication with providers

Educación

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

RN with psychiatric/behavioral health experience

Descripción del empleo

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role. You will review behavioral health authorizations, determine medical necessity, and ensure appropriate levels of care for inpatient mental health, detox, and substance-use rehab.

The ideal candidate is a licensed behavioral health professional or psychiatric RN with Utilization Management experience, able to work 12:00 PM–8:30 PM EST, Monday–Friday, and collaborate with providers and facilities to