Remote Behavioral Health Precertification Clinician

CVS Health Corporation; Salt Lake City (UT); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Fully remote

Weekdays schedule

Comprehensive benefits

Job summary

CVS Health Corporation is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role with a 12:00 PM–8:30 PM EST schedule. The position focuses on reviewing behavioral health authorization requests and determining medical necessity for inpatient mental health, detox, and substance use programs.

Requires an active, unrestricted Master’s-level behavioral health license or an RN license with psychiatric BH experience, plus 1+ year UM/UM review and 3+ years inpatient BH

Qualifications

• Active, unrestricted Master’s-level Behavioral Health license in residence state (LMSW/LCSW/LISW/LPC or equivalent)
• Or active, unrestricted RN license with psychiatric/behavioral health experience
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience
• 3+ years of inpatient behavioral health in hospital setting
• Ability to work 12:00 PM – 8:30 PM EST

Responsibilities

• Review behavioral health assessments and treatment plans to evaluate medical necessity
• Apply evidence-based guidelines to authorization decisions
• Coordinate with facilities and providers to obtain information
• Document determinations and rationale clearly
• Support discharge planning and transitions of care
• Communicate authorization decisions to providers and internal stakeholders
• Identify opportunities to improve quality and reduce denials

Skills

Behavioral Health License

RN license (psychiatric/behavioral)

Education

MSW/LCSW/LISW/LPC or equivalent

ADN with BH experience (RN)

BSN preferred

Job description

CVS Health Corporation is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role with a 12:00 PM–8:30 PM EST schedule. The position focuses on reviewing behavioral health authorization requests and determining medical necessity for inpatient mental health, detox, and substance use programs.

Requires an active, unrestricted Master’s-level behavioral health license or an RN license with psychiatric BH experience, plus 1+ year UM/UM review and 3+ years inpatient BH