Remote Behavioral Health UM Clinician

CVS Health; Elm (PA); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Fully remote option

Great benefits

Competitive pay and bonus eligibility

Job summary

CVS Health is hiring a Behavioral Health Precertification/Utilization Management Clinician for a 100% remote role. You will review authorization requests, apply guidelines, and determine medical necessity for inpatient mental health, detox, and substance use programs.

The position requires a Master’s-level Behavioral Health license or an RN with psychiatric/behavioral health experience, with licensure in the state of residence.

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence (LMSW, LCSW, LISW, LPC or equivalent)
• OR 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 in a hospital setting
• 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 decisions
• Utilize Medicare coverage criteria when applicable
• Document determinations, rationale, and recommendations
• Coordinate with facilities/providers to obtain additional clinical information
• Support discharge planning and transitions of care
• Communicate authorization decisions to providers and internal stakeholders
• Identify patients who may benefit from additional programs or care management
• Participate in crisis queue coverage and patient triage

Skills

Behavioral Health license or RN with精神

Utilization Management experience

Inpatient behavioral health experience

Clinical decision making

Education

Master's in Behavioral Health (Social Work, Counseling, Psychology)

ADN with Behavioral Health 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 authorization requests, apply guidelines, and determine medical necessity for inpatient mental health, detox, and substance use programs.

The position requires a Master’s-level Behavioral Health license or an RN with psychiatric/behavioral health experience, with licensure in the state of residence.