Remote Behavioral Health UM Clinician

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

Benefits offered by this job

Fully remote

Weekday schedule

Benefits package

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote, weekday schedule (12:00 PM – 8:30 PM EST). The role reviews behavioral health authorization requests, applies guidelines, and supports evidence-based care decisions to ensure appropriate levels of care for members.

The ideal candidate has a Master’s-level Behavioral Health license or an RN license with psychiatric/behavioral health experience, plus 1+ year of utilization review and 3+ years inpatient

Qualifications

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

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 when applicable and document determinations clearly.
• Coordinate with facilities and providers to obtain additional clinical information when needed.
• Support discharge planning and transitions of care; communicate decisions to providers and internal stakeholders.
• Identify members who may benefit from additional clinical programs or care management support.
• Participate in crisis queue coverage, including patient triage, call handling, escalation, and documentation.

Education

Master’s degree in Behavioral Health/related field

Associate Degree in Nursing (ADN) with Behavioral Health experience

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote, weekday schedule (12:00 PM – 8:30 PM EST). The role reviews behavioral health authorization requests, applies guidelines, and supports evidence-based care decisions to ensure appropriate levels of care for members.

The ideal candidate has a Master’s-level Behavioral Health license or an RN license with psychiatric/behavioral health experience, plus 1+ year of utilization review and 3+ years inpatient