Remote Behavioral Health Precertification UM Clinician

CVS Health; Yuma (AZ); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Fully remote opportunity

Consistent weekday schedule

Comprehensive benefits package

Medical, dental, and vision coverage

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote, weekday schedule (12:00 PM – 8:30 PM EST). The role reviews authorization requests, applying evidence-based guidelines to determine medical necessity and appropriate levels of care, with focus on inpatient mental health and substance use programs.

You will document determinations, coordinate with facilities, and support transitions of care while leveraging strong clinical judgment and utilization

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in home state.
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience.
• ≈3+ years of inpatient behavioral health experience in a hospital setting.
• Recent behavioral health experience or continuous behavioral health-focused work history.
• Strong clinical decision-making and medical necessity review skills.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate levels of care.
• Apply evidence-based behavioral health guidelines to authorization decisions.
• Document determinations, rationale, and recommendations thoroughly.
• Coordinate with facilities and providers to obtain additional clinical information when needed.
• Support discharge planning and transitions of care.
• Identify members who may benefit from additional clinical programs, services, or care management support.
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization.

Skills

Utilization Management

Clinical decision making

Documentation accuracy

Medicare guidelines knowledge

Strong typing / computer skills

Education

Master's degree in Behavioral Health

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote, weekday schedule (12:00 PM – 8:30 PM EST). The role reviews authorization requests, applying evidence-based guidelines to determine medical necessity and appropriate levels of care, with focus on inpatient mental health and substance use programs.

You will document determinations, coordinate with facilities, and support transitions of care while leveraging strong clinical judgment and utilization