Remote Behavioral Health UM Clinician

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

Benefits offered by this job

Fully remote role

Consistent weekday schedule

Comprehensive benefits package

Job summary

CVS Health invites experienced Behavioral Health clinicians or Psychiatric RNs to join as a remote Behavioral Health Precertification/UM Clinician. You will review authorization requests, assess medical necessity, and determine appropriate levels of care across inpatient mental health, detox, and substance use programs.

You will apply evidence-based guidelines, document decisions, coordinate with facilities, and support transitions of care.

Qualifications

• Active, unrestricted Master’s level Behavioral Health license in the state of residence (e.g., LMSW, LCSW, LISW, LPC or equivalent).
• Active, unrestricted Registered Nurse (RN) license with psychiatric/behavioral health experience.
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience.
• 3+ years of inpatient behavioral health experience in a hospital setting.
• Ability to work the scheduled hours of 12:00 PM – 8:30 PM EST.
• Strong clinical decision-making and medical necessity review skills.

Responsibilities

• Review behavioral health assessments, treatment plans, progress notes, and clinical documentation to evaluate medical necessity.
• 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 and thoroughly.
• Coordinate with facilities and providers to obtain additional clinical information when needed.
• Support discharge planning and transitions of care; communicate decisions to providers and stakeholders.
• Identify members who may benefit from additional clinical programs or care management support.
• Participate in crisis queue coverage and related duties.
• Identify opportunities to reduce denials and optimize benefit utilization.

Skills

Utilization Management

Clinical decision-making

Documentation

Care coordination

Crisis queue support

Education

Master's level Behavioral Health license

Associate Degree in Nursing (ADN) with BH experience

BSN preferred

Job description

CVS Health invites experienced Behavioral Health clinicians or Psychiatric RNs to join as a remote Behavioral Health Precertification/UM Clinician. You will review authorization requests, assess medical necessity, and determine appropriate levels of care across inpatient mental health, detox, and substance use programs.

You will apply evidence-based guidelines, document decisions, coordinate with facilities, and support transitions of care.