Remote Behavioral Health UM Clinician

CVS Health; South Dakota; À distance; USD 54 000 - 117 000; Plein temps

Avantages offerts par ce poste

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Additional benefits

Résumé du poste

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests and determine medical necessity for inpatient mental health, detox, and substance use rehab in a fully remote role.

The role requires an active Behavioral Health license or an RN with psychiatric experience, 1+ year of UM review, and 3+ years inpatient BH experience; shift 12:00 PM–8:30 PM EST, weekdays.

Qualifications

• 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 or Utilization Management experience.
• 3+ years of inpatient behavioral health experience in a hospital setting.
• Ability to work the scheduled hours 12:00 PM – 8:30 PM EST.

Responsabilités

• Review behavioral health assessments and documentation to evaluate medical necessity.
• Apply evidence-based guidelines and Medicare criteria when applicable.
• Document determinations and recommendations thoroughly.
• Coordinate with facilities to obtain additional clinical information.
• Support discharge planning and transitions of care.
• Communicate decisions to providers and internal stakeholders.
• Identify opportunities to improve quality and reduce denials.
• Participate in crisis queue coverage.

Connaissances

Behavioral Health license

RN license (psychiatric)

Formation

Master's Degree in Behavioral Health

ADN in Nursing with Behavioral Health experience

BSN preferred

Description du poste

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests and determine medical necessity for inpatient mental health, detox, and substance use rehab in a fully remote role.

The role requires an active Behavioral Health license or an RN with psychiatric experience, 1+ year of UM review, and 3+ years inpatient BH experience; shift 12:00 PM–8:30 PM EST, weekdays.