Remote Behavioral Health Precertification Clinician

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

Benefits offered by this job

Fully remote

Bonus program

Benefits package

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role, with a weekday schedule 12:00 PM–8:30 PM EST. You will review authorization requests, apply guidelines, and coordinate care to ensure medically necessary treatment.

Ideal candidates hold a Master's-level BH license or an RN with psychiatric BH experience, plus 1+ year in UM/UR and 3+ years inpatient BH experience. Excellent documentation and collaboration skills are essential.

Qualifications

• Active, unrestricted Master’s-level Behavioral Health license in the resident state (e.g., LMSW, LCSW, LISW, LPC)
• Active, unrestricted RN license with psychiatric/behavioral health experience
• 1+ year of BH 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 BH authorization requests and clinical documentation to evaluate medical necessity
• Apply evidence-based BH guidelines to authorization decisions
• Coordinate with facilities 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
• Participate in crisis queue coverage and member triage

Skills

Behavioral Health license

RN license (psychiatric)

Utilization Management

Inpatient behavioral health

Clinical decision-making

Documentation skills

Crisis queue handling

Education

Master's in Behavioral Health

ADN with BH experience

BSN preferred

Tools

EHR systems

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role, with a weekday schedule 12:00 PM–8:30 PM EST. You will review authorization requests, apply guidelines, and coordinate care to ensure medically necessary treatment.

Ideal candidates hold a Master's-level BH license or an RN with psychiatric BH experience, plus 1+ year in UM/UR and 3+ years inpatient BH experience. Excellent documentation and collaboration skills are essential.