Remote Behavioral Health Precertification Clinician

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

Benefits offered by this job

Fully remote

Comprehensive benefits package

Bonus eligibility

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests and determine medical necessity for inpatient mental health and substance use care. This 100% remote, full-time role operates on a 12:00 PM–8:30 PM EST schedule, supporting utilization management decisions with evidence-based guidelines and timely documentation.

Active behavioral health licensure or an RN with psychiatric experience is required, along with utilization review/UM experience and

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in state of residence (LMSW/LCSW/LISW/LPC or equivalent).
• 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.
• Ability to work the scheduled hours of 12:00 PM – 8:30 PM EST.
• Strong clinical decision-making and medical necessity review 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 practice standards to decisions.
• Utilize Medicare coverage criteria when applicable and document determinations thoroughly.
• Coordinate with facilities and providers to obtain additional clinical information as needed.
• Support discharge planning and transitions of care and communicate decisions to providers.

Skills

Licensed behavioral health license

RN with behavioral health experience

Education

Master's degree in social work, counseling, psychology, or related behavioral health field

ADN with behavioral health experience

BSN preferred

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests and determine medical necessity for inpatient mental health and substance use care. This 100% remote, full-time role operates on a 12:00 PM–8:30 PM EST schedule, supporting utilization management decisions with evidence-based guidelines and timely documentation.

Active behavioral health licensure or an RN with psychiatric experience is required, along with utilization review/UM experience and