Remote Behavioral Health UM Clinician

CVS Health

Clifton (TX)

Remote

USD 54,000 - 117,000

Full time

9 days ago

A complete application in a minute

Tailored resume and cover letter, ready to send.

Get past ATS filters

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role to review authorization requests and determine medical necessity for behavioral health services. This licensed professional or psychiatric RN role focuses on ensuring appropriate levels of care across inpatient mental health, detox, and substance use programs.

Qualified candidates will hold an active behavioral health license or an RN license with psychiatric/behavioral health experience, plus 1+ year

Qualifications

Active, unrestricted behavioral health license (state of residence) such as LMSW/LCSW/LISW/LPC or equivalent
Active, unrestricted RN license with psychiatric/behavioral health experience
1+ year of Behavioral Health Utilization Review or UM experience
3+ years of inpatient behavioral health experience in hospital setting
Able to work 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
Apply evidence-based behavioral health guidelines 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 and next steps to providers and internal stakeholders
Identify opportunities to improve quality and reduce denials