Remote Behavioral Health UM Clinician

CVS Health; Montana City (MT); 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 clinical documentation for medical necessity and appropriate levels of care. This 100% remote role supports inpatient mental health and substance use treatment decisions.

You will work with providers and facilities, document determinations clearly, and contribute to discharge planning and care coordination.

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence.
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience
• 3+ years of inpatient behavioral health experience in a hospital setting
• 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 authorization decisions
• Document determinations, rationale, and recommendations accurately and 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

Education

Master's in Behavioral Health fields

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 clinical documentation for medical necessity and appropriate levels of care. This 100% remote role supports inpatient mental health and substance use treatment decisions.

You will work with providers and facilities, document determinations clearly, and contribute to discharge planning and care coordination.