Remote Behavioral Health Precertification Clinician

CVS Health; Clayton (NM); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Medical coverage

Dental & Vision

Paid time off

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote position (Mon–Fri, 12:00 PM – 8:30 PM EST). Licensed Behavioral Health professionals or Psychiatric RNs with UM experience will review authorization requests to determine medical necessity and appropriate levels of care, focusing on inpatient mental health and substance use programs.

Responsibilities include applying evidence-based guidelines, documenting decisions, coordinating with facilities, supporting

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence.
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience.
• ≈3+ years of inpatient behavioral health experience in a hospital setting.
• ≈ Recent behavioral health experience or continuous behavioral health-focused work history.
• ≈ Strong clinical decision-making and medical necessity review skills.
• Working knowledge of Medicare Behavioral Health guidelines.
• Excellent typing, documentation and computer skills.

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 standards to decisions.
• Document determinations, rationale, and recommendations accurately.
• Coordinate with facilities and providers to obtain additional information when needed.
• Support discharge planning and transitions of care.
• Identify members who may benefit from additional programs or care management.
• Identify opportunities to improve quality, reduce denials and optimize benefit utilization.

Skills

Clinical decision-making

Medical necessity review

Documentation skills

Time management

Education

Master's Degree in Behavioral Health (Social Work, Counseling, Psychology)

ADN Nursing

BSN Nursing

Active Behavioral Health license (Master's level)

Tools

Electronic health records

Medicare Behavioral Health guidelines

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote position (Mon–Fri, 12:00 PM – 8:30 PM EST). Licensed Behavioral Health professionals or Psychiatric RNs with UM experience will review authorization requests to determine medical necessity and appropriate levels of care, focusing on inpatient mental health and substance use programs.

Responsibilities include applying evidence-based guidelines, documenting decisions, coordinating with facilities, supporting