Remote Behavioral Health UM Clinician

Preferra Insurance; Northern (KY); Híbrido; USD 54 000 - 117 000; Tempo integral

Resumo da oferta

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests and determine medical necessity for behavioral health services. This 100% remote role offers a consistent weekday schedule and focuses on inpatient mental health, detox, and substance use rehabilitation programs.

Candidates should have a relevant license, utilization management experience, and strong clinical decision-making.

Qualificações

• Active, unrestricted Master’s-level Behavioral Health license in the state of residence.
• If RN path, active 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.
• Ability to work the scheduled hours 12:00 PM - 8:30 PM EST.
• Strong clinical decision-making and medical necessity review skills.

Responsabilidades

• Review behavioral health authorization requests and clinical documentation to determine medical necessity.
• Apply evidence-based behavioral health guidelines and clinical standards to decisions.
• Coordinate with facilities and providers to obtain additional information.
• Support discharge planning and transitions of care.
• Communicate decisions to providers and internal stakeholders.
• Identify members who may benefit from additional programs and care management.
• Participate in crisis queue coverage and triage.
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization.

Conhecimentos

Clinical decision-making

Medical necessity review

Utilization management

Behavioral health expertise

Formação académica

Master's degree in Behavioral Health fields

Descrição da oferta de emprego

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests and determine medical necessity for behavioral health services. This 100% remote role offers a consistent weekday schedule and focuses on inpatient mental health, detox, and substance use rehabilitation programs.

Candidates should have a relevant license, utilization management experience, and strong clinical decision-making.