Remote Behavioral Health Precertification Clinician

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

Benefits offered by this job

Fully remote opportunity

Consistent weekday schedule

Specialized Behavioral Health UM role

Collaborative interdisciplinary teams

Meaningful impact on access to care

Job summary

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a fully remote, weekday schedule. You will review authorization requests for inpatient mental health, detox, and substance use programs, advising on medical necessity and appropriate care levels.

Ideal candidates hold a Master's-level behavioral health license or an RN with psychiatric experience, with 1+ year UM/UR and 3+ years inpatient behavioral health experience.

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence (e.g., LMSW, LCSW, LISW, LPC, equivalent).
• OR active, unrestricted Registered Nurse (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.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to evaluate medical necessity and appropriate level of care.
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions.
• Utilize Medicare coverage criteria where applicable and document determinations clearly.
• Coordinate with facilities and providers to obtain additional clinical information as needed.
• Support discharge planning and transitions of care; communicate decisions to providers and internal stakeholders.
• Identify opportunities to improve quality, reduce denials and optimize benefit utilization.

Education

Master's Degree in Behavioral Health (e.g., Social Work, Counseling, Psychology)

ADN with Behavioral Health experience

BSN (preferred)

Job description

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a fully remote, weekday schedule. You will review authorization requests for inpatient mental health, detox, and substance use programs, advising on medical necessity and appropriate care levels.

Ideal candidates hold a Master's-level behavioral health license or an RN with psychiatric experience, with 1+ year UM/UR and 3+ years inpatient behavioral health experience.