Remote Behavioral Health UM Clinician

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

Benefits offered by this job

Fully remote role

Competitive benefits package

Bonus eligibility

Job summary

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a 100% remote role. The position supports review of authorization requests with a focus on appropriate levels of care, ensuring timely, evidence-based treatment for members.

Qualified clinicians may hold a master's-level behavioral health license or be an RN with psychiatric/behavioral health experience. The role requires 1+ year of Utilization Review and 3+ years inpatient behavioral health in a

Qualifications

• Active behavioral health license in the state of residence (LMSW/LCSW/LISW/LPC or equivalent).
• RN with psychiatric/behavioral health experience also qualifies.
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience.
• 3+ years inpatient behavioral health experience in a hospital setting.
• Recent behavioral health-focused work history.

Responsibilities

• Review behavioral health authorization requests and clinical docs to determine medical necessity and level of care.
• Apply evidence-based guidelines and practice standards to authorization decisions.
• Utilize Medicare criteria where applicable and document determinations clearly.
• Coordinate with facilities/providers to obtain needed info and support transitions of care.
• Communicate decisions to providers and internal stakeholders; identify care-management opportunities.

Skills

Behavioral Health license

RN with psychiatric/behavioral health

Utilization Management experience

Inpatient behavioral health experience

Clinical decision-making

Education

Master's Degree in Behavioral Health field

ADN with Behavioral Health experience

BSN

Job description

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a 100% remote role. The position supports review of authorization requests with a focus on appropriate levels of care, ensuring timely, evidence-based treatment for members.

Qualified clinicians may hold a master's-level behavioral health license or be an RN with psychiatric/behavioral health experience. The role requires 1+ year of Utilization Review and 3+ years inpatient behavioral health in a