Remote Behavioral Health Precertification Clinician

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

Benefits offered by this job

Bonus eligibility

Remote work

Comprehensive benefits

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote, weekday role with a 12:00 PM – 8:30 PM EST schedule. You will review authorization requests, determine medical necessity, and support appropriate levels of care across inpatient, detox, and rehab settings.

The ideal candidate holds an active Behavioral Health license or an RN with psychiatric experience, with 1+ year in utilization management and 3+ years inpatient behavioral health.

Qualifications

• Active, unrestricted Master’s-level Behavioral Health license in state of residence (LMSW/LCSW/LISW/LPC or equivalent).
• OR active, unrestricted RN license with psychiatric/behavioral health experience.
• 1+ year of Behavioral Health Utilization Review or UM experience.
• 3+ years inpatient behavioral health experience.

Responsibilities

• Review behavioral health authorization requests and medical necessity.
• Apply evidence-based guidelines to authorization decisions.
• Coordinate with facilities to obtain needed information.
• Support discharge planning and transitions of care.
• Communicate decisions to providers and stakeholders.
• Identify members who may benefit from additional programs.

Skills

Behavioral health expertise

Utilization Management experience

Clinical decision-making

Medical necessity review

Crisis queue handling

Education

Master's degree in Behavioral Health

ADN nursing degree

BSN (preferred)

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote, weekday role with a 12:00 PM – 8:30 PM EST schedule. You will review authorization requests, determine medical necessity, and support appropriate levels of care across inpatient, detox, and rehab settings.

The ideal candidate holds an active Behavioral Health license or an RN with psychiatric experience, with 1+ year in utilization management and 3+ years inpatient behavioral health.