Remote Behavioral Health UM Clinician

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

Benefits offered by this job

Fully remote

Weekday hours

Behavioral Health UM

Impactful work

Collaborative team

Job summary

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a 100% remote, weekday role with hours 12:00 PM to 8:30 PM EST. This position reviews behavioral health authorizations and clinical documentation to determine medical necessity and appropriate levels of care, focusing on inpatient mental health, detoxification, and substance use rehabilitation programs.

You will apply evidence-based guidelines, utilize Medicare criteria when applicable, document

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 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
• 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 authorization decisions
• Utilize Medicare coverage criteria and requirements when applicable
• Document determinations, rationale, and recommendations accurately
• Coordinate with facilities and providers to obtain additional clinical information when needed
• Support discharge planning and transitions of care
• Communicate authorization decisions and next steps to providers and internal stakeholders
• Identify members who may benefit from additional clinical programs, services, or care management support
• Participate in crisis queue coverage, including member triage, call handling, escalation, and documentation
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization

Skills

Behavioral Health Utilization Review

Utilization Management

Clinical decision-making

Inpatient behavioral health

Education

Master's degree in Behavioral Health

RN license with psych/behavioral health experience

Job description

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a 100% remote, weekday role with hours 12:00 PM to 8:30 PM EST. This position reviews behavioral health authorizations and clinical documentation to determine medical necessity and appropriate levels of care, focusing on inpatient mental health, detoxification, and substance use rehabilitation programs.

You will apply evidence-based guidelines, utilize Medicare criteria when applicable, document