Remote Behavioral Health UM Clinician

CVS Health; Minneota (MN); Remote; USD 54,000 - 117,000; Full time

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests and determine medical necessity for inpatient mental health and substance use programs. This 100% remote, weekday role supports timely evidence-based care decisions.

You will assess clinical documentation, apply guidelines, coordinate with facilities, and assist discharge planning. A master's level Behavioral Health license and U.S.

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence (e.g., LPC).
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience.
• Approximately 3+ years of inpatient behavioral health experience in a hospital setting.
• Recent behavioral health-focused work history and strong clinical decision-making.

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.
• Document determinations, rationale, and recommendations thoroughly.
• Coordinate with facilities and providers to obtain additional clinical information when needed.
• Support discharge planning and transitions of care.
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization.

Skills

Clinical decision-making

Medical necessity review

Documentation skills

Communication skills

Education

Master's Degree in Social Work, Counseling, Psychology, or another Behavioral Health discipline

Associate Degree in Nursing (ADN)

Bachelor of Science in Nursing (BSN)

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests and determine medical necessity for inpatient mental health and substance use programs. This 100% remote, weekday role supports timely evidence-based care decisions.

You will assess clinical documentation, apply guidelines, coordinate with facilities, and assist discharge planning. A master's level Behavioral Health license and U.S.