Remote Behavioral Health Precertification Clinician

CVS Health; East Windsor Hill (CT); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Fully remote

Weekday schedule

Bonus potential

Job summary

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician to review authorization requests and clinical documentation, determining medical necessity and appropriate levels of care for behavioral health services.

This 100% remote, Monday–Friday role requires a licensed Behavioral Health professional or Psychiatric RN with UM experience, including inpatient behavioral health work and strong documentation skills.

Qualifications

• Active, unrestricted behavioral health license in the 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 of Behavioral Health Utilization Review or Utilization Management experience.
• 3+ years of inpatient behavioral health experience in a hospital setting.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to evaluate 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 information as needed.
• Support discharge planning and transitions of care.
• Communicate authorization decisions and next steps to providers and internal stakeholders.

Skills

Behavioral health licensing

RN licensure with psych experience

Education

Master's Degree in Social Work

Master's Degree in Counseling

Master's Degree in Psychology

Job description

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician to review authorization requests and clinical documentation, determining medical necessity and appropriate levels of care for behavioral health services.

This 100% remote, Monday–Friday role requires a licensed Behavioral Health professional or Psychiatric RN with UM experience, including inpatient behavioral health work and strong documentation skills.