Remote Behavioral Health Precertification Clinician

CVS Health; Yorktown (VA); A distancia; USD 54.000 - 117.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote work

Comprehensive benefits

Descripción de la vacante

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review behavioral health authorization requests and determine medical necessity, focusing on inpatient mental health, substance use rehabilitation, and appropriate levels of care. This 100% remote role follows a Monday–Friday schedule 12:00 PM–8:30 PM EST.

Candidates must hold an active master's-level Behavioral Health license in their state of residence (e.g., LPC), have UR/UM experience, and 3+ years inpatient

Formación

• Licensed Behavioral Health professional in the state of residence.
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience.
• Approximately 3+ years of inpatient behavioral health in a hospital setting.
• Strong clinical decision-making and medical necessity review skills.
• Proficiency in accurate documentation and coordination with facilities.

Responsabilidades

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and levels of care.
• Apply evidence-based behavioral health guidelines and clinical standards.
• Document determinations, rationale, and recommendations thoroughly.
• Coordinate with facilities and providers for additional information as needed.
• Support discharge planning and transitions of care.
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization.

Conocimientos

Utilization Review

Clinical decision-making

Documentation

Medical necessity review

Educación

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

RN ADN with Behavioral Health experience

RN BSN

Descripción del empleo

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review behavioral health authorization requests and determine medical necessity, focusing on inpatient mental health, substance use rehabilitation, and appropriate levels of care. This 100% remote role follows a Monday–Friday schedule 12:00 PM–8:30 PM EST.

Candidates must hold an active master's-level Behavioral Health license in their state of residence (e.g., LPC), have UR/UM experience, and 3+ years inpatient