Remote Behavioral Health UM Clinician

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

Benefits offered by this job

Fully remote

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role. You will review authorization requests, apply guidelines, and coordinate with facilities to ensure appropriate care.

Requirements include a master’s level Behavioral Health license or an RN with psychiatric experience, plus 1+ year in Utilization Review and 3+ years inpatient behavioral health in hospitals. This role offers a weekday schedule, strong benefits, and the chance to impact access to

Qualifications

• Active, unrestricted Behavioral Health license in the state of residence or RN with behavioral health experience.
• Minimum 1 year in Behavioral Health Utilization Review or Utilization Management.
• Minimum 3 years inpatient behavioral health experience in a hospital setting.
• Scheduled hours are 12:00 PM–8:30 PM EST; ability to cover this shift.
• Strong clinical decision-making and medical necessity review skills.

Responsibilities

• Review behavioral health authorization requests and documentation to determine medical necessity.
• Apply evidence-based guidelines and Medicare criteria when applicable.
• Document determinations, rationale, and recommendations clearly.
• Coordinate with facilities/providers for additional information as needed.
• Support discharge planning and transitions of care; communicate decisions to stakeholders.
• Identify opportunities to improve quality, reduce denials, and optimize utilization.

Skills

Licensing in Behavioral Health or RN

UM/Utilization Review experience

Inpatient behavioral health experience

Ability to work 12:00 PM–8:30 PM EST

Clinical decision-making

Education

Master's in Social Work / Counseling / Psychology

RN with Behavioral Health experience (ADN/BSN)

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role. You will review authorization requests, apply guidelines, and coordinate with facilities to ensure appropriate care.

Requirements include a master’s level Behavioral Health license or an RN with psychiatric experience, plus 1+ year in Utilization Review and 3+ years inpatient behavioral health in hospitals. This role offers a weekday schedule, strong benefits, and the chance to impact access to