Remote Behavioral Health Precertification Clinician

CVS Health; Guin (AL); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Fully remote opportunity

Comprehensive benefits package

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for 100% remote work with a consistent weekday schedule (12:00 PM – 8:30 PM EST). The role focuses on reviewing behavioral health authorization requests, ensuring medical necessity and appropriate levels of care.

The candidate should have a behavioral health license or an RN with psychiatric experience, plus 1+ year of utilization review and 3+ years in inpatient BH.

Qualifications

• Active, unrestricted behavioral health license in state (e.g., LMSW, LCSW, LISW, LPC).
• Registered Nurse with psychiatric/behavioral health experience.
• 1+ year of BH Utilization Review or UM experience.
• 3+ years inpatient behavioral health in a hospital setting.
• Ability to work 12:00 PM–8:30 PM EST.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to evaluate medical necessity.
• Apply evidence-based guidelines and clinical 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 to providers and stakeholders.
• Identify opportunities to improve quality and reduce denials.

Skills

Utilization Review

Clinical decision-making

Behavioral health

Evidence-based guidelines

Communication skills

Education

MSW / related behavioral health degree

RN with psychiatric license

ADN with BH experience

BSN (preferred)

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for 100% remote work with a consistent weekday schedule (12:00 PM – 8:30 PM EST). The role focuses on reviewing behavioral health authorization requests, ensuring medical necessity and appropriate levels of care.

The candidate should have a behavioral health license or an RN with psychiatric experience, plus 1+ year of utilization review and 3+ years in inpatient BH.