Remote Behavioral Health Precertification Clinician

CVS Health; Orangeburg (SC); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Fully remote opportunity

Consistent weekday schedule

Comprehensive benefits package

Job summary

CVS Health in the United States is seeking a Behavioral Health Precertification/UM Clinician to review behavioral health authorization requests, determine medical necessity and appropriate levels of care, with a focus on inpatient mental health, detoxification and substance use rehabilitation.

This 100% remote, full‑time role offers a consistent weekday schedule (Mon–Fri, 12:00 PM–8:30 PM EST) and a comprehensive benefits package, with the chance to improve access to timely, evidence‑based care

Qualifications

• Active, unrestricted license in Behavioral Health (Master's level) in state of residence (e.g., LMSW, LCSW, LISW, LPC) or equivalent independent clinical license.
• Active, unrestricted RN license with psychiatric/behavioral health experience.
• 1+ year Behavioral Health Utilization Review or Utilization Management experience.
• 3+ years inpatient behavioral health experience in 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 and clinical documentation to evaluate medical necessity and appropriate levels of care.
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions.
• Utilize Medicare coverage criteria when applicable.
• Document determinations, rationale, and recommendations.
• Coordinate with facilities and providers to obtain additional clinical information as needed.
• Support discharge planning and transitions of care.
• Communicate authorization decisions to providers and internal stakeholders.
• Identify members who may benefit from additional clinical programs or care management.

Skills

BH licensure

RN license

Utilization Management

Behavioral health

Education

Master's degree in Behavioral Health

ADN/BSN in Nursing

Tools

EHR systems

Job description

CVS Health in the United States is seeking a Behavioral Health Precertification/UM Clinician to review behavioral health authorization requests, determine medical necessity and appropriate levels of care, with a focus on inpatient mental health, detoxification and substance use rehabilitation.

This 100% remote, full‑time role offers a consistent weekday schedule (Mon–Fri, 12:00 PM–8:30 PM EST) and a comprehensive benefits package, with the chance to improve access to timely, evidence‑based care