Remote Behavioral Health UM Clinician

CVS Health; Iowa Center (IA); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Retirement savings options

Paid time off

Wellness programs

Bonus eligibility

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to work remotely in the United States. This full-time role focuses on reviewing authorization requests to ensure medical necessity for inpatient mental health, detox, and rehab services, with a 12:00 PM–8:30 PM EST schedule.

You will apply evidence-based guidelines, document decisions, coordinate with facilities, and support transitions of care while contributing to quality improvement and ensuring timely access to care.

Qualifications

• 1+ year of Behavioral Health Utilization Review or Utilization Management experience
• 3+ years of inpatient behavioral health experience in a hospital setting
• Recent behavioral health-focused work history
• Ability to work the 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
• Apply evidence-based behavioral health guidelines and clinical practice standards to decisions
• Utilize Medicare coverage criteria when applicable
• Document determinations, rationale, and recommendations clearly
• Coordinate with facilities to obtain needed clinical information
• Support discharge planning and transitions of care
• Communicate authorization decisions to providers and internal stakeholders
• Identify opportunities to improve quality and reduce denials
• Participate in crisis queue coverage and member triage

Skills

Utilization Management

Behavioral Health expertise

Clinical documentation

Communication skills

Crisis queue handling

Education

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

RN license with psychiatric/behavioral health experience

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to work remotely in the United States. This full-time role focuses on reviewing authorization requests to ensure medical necessity for inpatient mental health, detox, and rehab services, with a 12:00 PM–8:30 PM EST schedule.

You will apply evidence-based guidelines, document decisions, coordinate with facilities, and support transitions of care while contributing to quality improvement and ensuring timely access to care.