Remote Behavioral Health Precertification Clinician

Voices for Voices; Northern (KY); Hybrid; USD 54,000 - 117,000; Full time

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to join our remote team. This full-time role focuses on reviewing authorization requests, applying evidence-based guidelines, and ensuring timely, appropriate care for behavioral health patients.

Candidates will review documentation, coordinate with facilities, support discharge planning, and communicate decisions to providers and stakeholders, with a schedule 12:00 PM - 8:30 PM EST and a 40-hour workweek.

Qualifications

• Active, unrestricted Master’s-level Behavioral Health license in the state of residence.
• 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.
• Strong clinical decision-making and medical necessity review skills.

Responsibilities

• Review behavioral health authorization requests to determine medical necessity and appropriate levels of care.
• Apply evidence-based behavioral health guidelines to authorization decisions.
• 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 and member triage.
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization.

Skills

Behavioral health license

Utilization management

Inpatient BH experience

Clinical decision-making

Education

Master's Degree in Behavioral Health

ADN with Behavioral Health experience

BSN preferred

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to join our remote team. This full-time role focuses on reviewing authorization requests, applying evidence-based guidelines, and ensuring timely, appropriate care for behavioral health patients.

Candidates will review documentation, coordinate with facilities, support discharge planning, and communicate decisions to providers and stakeholders, with a schedule 12:00 PM - 8:30 PM EST and a 40-hour workweek.