Remote Behavioral Health UM Clinician

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

Benefits offered by this job

Remote work

Job summary

CVS Health is hiring a Behavioral Health Precertification/Utilization Management Clinician for a 100% remote role. You will review behavioral health authorizations and clinical documentation to ensure medical necessity and appropriate levels of care, focusing on inpatient mental health, detox, and substance use rehab.

The role requires an active behavioral health license or an RN with psychiatric experience, 1+ year UM/UR work, and 3+ years inpatient BH in a hospital setting.

Qualifications

• 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-focused work history.
• Ability to work 12:00 PM – 8:30 PM EST.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine 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 clearly.
• Coordinate with facilities and providers to obtain additional clinical information.
• 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

Utilization Management

Inpatient Behavioral Health

Clinical decision-making

Schedule 12:00–8:30 PM EST

Education

Master's Degree in Social Work / Counseling / Psychology

ADN with BH experience (RN)

BSN (preferred)

Job description

CVS Health is hiring a Behavioral Health Precertification/Utilization Management Clinician for a 100% remote role. You will review behavioral health authorizations and clinical documentation to ensure medical necessity and appropriate levels of care, focusing on inpatient mental health, detox, and substance use rehab.

The role requires an active behavioral health license or an RN with psychiatric experience, 1+ year UM/UR work, and 3+ years inpatient BH in a hospital setting.