Remote Behavioral Health UM Clinician

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

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Remote work

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role. The position focuses on reviewing authorization requests and applying evidence-based guidelines to determine medical necessity and appropriate levels of care.

Ideal candidates hold a Master’s-level Behavioral Health license or an RN with psychiatric/behavioral health experience, plus 1+ year of Utilization Management and 3+ years inpatient behavioral health experience. Hours: 12:00 PM–8:30 PM EST.

Qualifications

• Must hold an 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 of Behavioral Health Utilization Review/Utilization Management experience.
• 3+ years of inpatient behavioral health experience in a hospital setting.
• 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 level of care.
• Apply evidence-based behavioral health guidelines and clinical standards to authorization decisions.
• Coordinate with facilities/providers to obtain additional information when needed.
• Support discharge planning and transitions of care.
• Communicate authorization decisions to providers and internal stakeholders.
• Identify members who may benefit from additional clinical programs and care management.

Skills

Utilization Review

Clinical decision-making

Medical necessity

Documentation skills

Communication skills

Education

Master's Degree in Social Work/Counseling/Psychology

Associate Degree in Nursing (ADN)

BSN preferred

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role. The position focuses on reviewing authorization requests and applying evidence-based guidelines to determine medical necessity and appropriate levels of care.

Ideal candidates hold a Master’s-level Behavioral Health license or an RN with psychiatric/behavioral health experience, plus 1+ year of Utilization Management and 3+ years inpatient behavioral health experience. Hours: 12:00 PM–8:30 PM EST.