Remote Behavioral Health UM Clinician

CVS Health; South Dakota Park (SD); A distancia; USD 54.000 - 117.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Fully remote

Descripción de la vacante

CVS Health is hiring a Behavioral Health Precertification/UM Clinician for a fully remote, weekday schedule (12:00 PM – 8:30 PM EST). You will review authorization requests, determine medical necessity, and support appropriate levels of care for inpatient mental health, detox services, and substance use rehab.

The role requires a licensed behavioral health professional or psychiatric RN with utilization management experience and a strong focus on evidence-based care decisions and collaboration

Formación

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

Responsabilidades

• Review behavioral health authorization requests and clinical documentation to evaluate medical necessity
• Apply evidence-based behavioral health guidelines to authorization decisions
• Coordinate with facilities to obtain additional clinical information as needed
• Support discharge planning and transitions of care
• Communicate authorization decisions to providers and internal stakeholders
• Identify opportunities to improve quality and reduce denials

Conocimientos

Clinical decision-making

Utilization Management experience

Inpatient behavioral health

Documentation skills

Educación

Master's Degree in Social Work, Counseling, Psychology or related Behavioral Health field

ADN with Behavioral Health experience

BSN (preferred)

Descripción del empleo

CVS Health is hiring a Behavioral Health Precertification/UM Clinician for a fully remote, weekday schedule (12:00 PM – 8:30 PM EST). You will review authorization requests, determine medical necessity, and support appropriate levels of care for inpatient mental health, detox services, and substance use rehab.

The role requires a licensed behavioral health professional or psychiatric RN with utilization management experience and a strong focus on evidence-based care decisions and collaboration