Remote Behavioral Health UM Clinician

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

Benefits offered by this job

Fully remote environment

Comprehensive benefits package

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role with a weekday schedule. The position focuses on reviewing authorization requests for inpatient mental health, detox, and substance use programs, ensuring medical necessity and appropriate levels of care.

The candidate will apply evidence-based guidelines, utilize Medicare criteria where applicable, document decisions, and collaborate with facilities to obtain needed information.

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the resident state (e.g., LMSW, LCSW, LISW, LPC, equivalent).
• Or active, unrestricted RN license with psychiatric/behavioral health experience.
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience.
• 3+ years inpatient behavioral health experience in a hospital setting.
• Ability to work the scheduled hours 12:00 PM – 8:30 PM EST.

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 Medicare criteria where applicable.
• Document determinations, rationale, and recommendations clearly.
• Coordinate with facilities/providers to obtain additional clinical information as needed.
• Support discharge planning and transitions of care; communicate decisions to providers and stakeholders.

Skills

Behavioral health licensure

Utilization Management

Clinical decision-making

Documentation accuracy

Team collaboration

Education

Master's degree in Social Work, Counseling, Psychology, or related Behavioral Health field

RN with psychiatric/behavioral health experience (optional)

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role with a weekday schedule. The position focuses on reviewing authorization requests for inpatient mental health, detox, and substance use programs, ensuring medical necessity and appropriate levels of care.

The candidate will apply evidence-based guidelines, utilize Medicare criteria where applicable, document decisions, and collaborate with facilities to obtain needed information.