Remote Behavioral Health UM Clinician

CVS Health; Bristol (RI); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Fully remote

Weekday schedule

Bonus eligibility

Competitive benefits

Job summary

CVS Health is hiring a Behavioral Health Precertification/UM Clinician for a 100% remote role with a Monday–Friday, 12:00 PM–8:30 PM EST schedule. Responsibilities include reviewing behavioral health authorizations, applying evidence-based guidelines, and coordinating with facilities to ensure timely, appropriate care.

The position requires a Master’s-level Behavioral Health license or an RN with psychiatric experience, 1+ year in Utilization Management, and 3+ years in inpatient behavioral

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence (e.g., LMSW/LCSW/LISW/LPC or equivalent).
• Active, unrestricted Registered Nurse (RN) license with psychiatric/behavioral health experience.

Responsibilities

• Review behavioral health assessments, treatment plans, progress notes, and clinical documentation to evaluate medical necessity.
• 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 accurately and thoroughly.
• Coordinate with facilities and providers to obtain additional clinical information when needed.
• 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, services, 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

RN license (psychiatric)

Education

Master's in Behavioral Health

ADN with Behavioral Health experience

BSN preferred

Job description

CVS Health is hiring a Behavioral Health Precertification/UM Clinician for a 100% remote role with a Monday–Friday, 12:00 PM–8:30 PM EST schedule. Responsibilities include reviewing behavioral health authorizations, applying evidence-based guidelines, and coordinating with facilities to ensure timely, appropriate care.

The position requires a Master’s-level Behavioral Health license or an RN with psychiatric experience, 1+ year in Utilization Management, and 3+ years in inpatient behavioral