Remote Behavioral Health Precertification Clinician

CVS Health; Milton (MA); Remote; USD 54,000 - 117,000; Full time

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests and determine medical necessity, focusing on inpatient mental health and substance use rehabilitation programs. You will document determinations and coordinate with facilities to gather additional information, supporting discharge planning and care transitions.

The role is 100% remote with a consistent Monday–Friday schedule and a comprehensive benefits package designed to support colleagues

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence (e.g., LPC)
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience
• ~3+ years of inpatient behavioral health experience in a hospital setting
• ~Recent behavioral health experience or continuous behavioral health-focused work history
• ~ Strong clinical decision-making and medical necessity review skills
• Working knowledge of Medicare Behavioral Health guidelines
• Strong typing and keyboarding skills
• Excellent documentation and computer skills

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate levels of care
• Focus on inpatient mental health and substance use rehabilitation program reviews
• Apply evidence-based guidelines and clinical practice standards to authorization decisions
• Document determinations, rationale, and recommendations accurately
• Coordinate with facilities and providers to obtain additional information when needed
• Support discharge planning and transitions of care
• Identify members who may benefit from additional clinical programs or care management
• Identify opportunities to improve quality and reduce denials

Skills

Clinical decision-making

Documentation skills

Computer proficiency

Typing speed

Medicare Behavioral Health guidelines

Education

Master's Degree in Social Work, Counseling, Psychology, or another Behavioral Health discipline

ADN with Behavioral Health experience

BSN

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests and determine medical necessity, focusing on inpatient mental health and substance use rehabilitation programs. You will document determinations and coordinate with facilities to gather additional information, supporting discharge planning and care transitions.

The role is 100% remote with a consistent Monday–Friday schedule and a comprehensive benefits package designed to support colleagues