Remote Behavioral Health Precertification Clinician

CVS Health; Lorida (FL); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Fully remote

Competitive benefits

Weekday schedule

Annual bonus eligibility

Job summary

CVS Health is hiring a Behavioral Health Precertification/UM Clinician for a fully remote, weekday schedule. The role reviews behavioral health authorization requests to ensure medical necessity and appropriate levels of care, focusing on inpatient mental health, detox, and substance use rehabilitation programs.

The ideal candidate holds an active Behavioral Health license (LMSW/LCSW/LISW/LPC or equivalent) or an RN with psychiatric/behavioral health experience, with 1+ year of UM experience and

Qualifications

• Master's level Behavioral Health licensure in the resident state (LMSW/LCSW/LISW/LPC or equivalent).
• 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 12:00 PM–8:30 PM EST.

Responsibilities

• Review behavioral health assessments, treatment plans, progress notes, and clinical documentation to evaluate medical necessity.
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions.
• Utilize Medicare coverage criteria and requirements when applicable.
• Document determinations, rationale, and recommendations accurately and thoroughly.
• Coordinate with facilities and providers to obtain additional clinical information when needed.
• Support discharge planning and transitions of care.
• Communicate authorization decisions and next steps to providers and internal stakeholders.
• Identify members who may benefit from additional clinical programs or care management support.
• Participate in crisis queue coverage, including member triage, call handling, escalation, and documentation.
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization.

Education

Master's degree in Social Work, Counseling, Psychology

Associate Degree in Nursing (ADN) focused on Behavioral Health

BSN preferred

Job description

CVS Health is hiring a Behavioral Health Precertification/UM Clinician for a fully remote, weekday schedule. The role reviews behavioral health authorization requests to ensure medical necessity and appropriate levels of care, focusing on inpatient mental health, detox, and substance use rehabilitation programs.

The ideal candidate holds an active Behavioral Health license (LMSW/LCSW/LISW/LPC or equivalent) or an RN with psychiatric/behavioral health experience, with 1+ year of UM experience and