Remote Behavioral Health UM Clinician

CVS Health; Alton (IL); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Bonus program

Comprehensive benefits package

Fully remote

Job summary

CVS Health is hiring for a Behavioral Health Precertification/Utilization Management Clinician in a fully remote capacity. The role supports behavioral health authorizations with emphasis on medical necessity and appropriate levels of care, including inpatient mental health, detox, and rehab services.

The candidate should hold an active Behavioral Health license (e.g., LMSW/LCSW/LISW/LPC) or an RN with psychiatric experience, with 1+ year UM/UR experience and 3+ years inpatient behavioral health

Qualifications

• Active, unrestricted Master’s-level Behavioral Health license in the state of residence (e.g., LMSW, LCSW, LISW, LPC)
• Active, unrestricted Registered Nurse (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 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 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 and requirements when applicable
• Document determinations, rationale, and recommendations thoroughly
• Coordinate with facilities and providers to obtain additional clinical information
• 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 support
• Participate in crisis queue coverage, including member triage, call handling, escalation, and documentation
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization

Skills

Behavioral Health license (LMSW/LCSW/L

Job description

CVS Health is hiring for a Behavioral Health Precertification/Utilization Management Clinician in a fully remote capacity. The role supports behavioral health authorizations with emphasis on medical necessity and appropriate levels of care, including inpatient mental health, detox, and rehab services.

The candidate should hold an active Behavioral Health license (e.g., LMSW/LCSW/LISW/LPC) or an RN with psychiatric experience, with 1+ year UM/UR experience and 3+ years inpatient behavioral health