Remote Behavioral Health UM Clinician

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

Benefits offered by this job

Fully remote

Weekday schedule

Bonus program

Job summary

CVS Health is hiring a Behavioral Health Precertification/UM Clinician for a 100% remote role. You will review behavioral health authorization requests, assess medical necessity, and determine appropriate levels of care, focusing on inpatient mental health, detoxification, and substance use rehabilitation programs.

The position requires a licensed behavioral health professional or psychiatric RN with Utilization Management experience, with hours from 12:00 PM to 8:30 PM EST and a competitive

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
• 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 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 authorization decisions and next steps to providers and internal stakeholders
• Identify members who may benefit from additional clinical programs, services, or care management support
• Participate in crisis queue coverage and member triage
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization

Skills

Clinical decision-making

Utilization Management

Communication skills

Documentation

Education

Master's Degree in Social Work, Counseling, Psychology, or another Behavioral Health discipline

Associate Degree in Nursing (ADN) with Behavioral Health experience

Bachelor of Science in Nursing (BSN)

Job description

CVS Health is hiring a Behavioral Health Precertification/UM Clinician for a 100% remote role. You will review behavioral health authorization requests, assess medical necessity, and determine appropriate levels of care, focusing on inpatient mental health, detoxification, and substance use rehabilitation programs.

The position requires a licensed behavioral health professional or psychiatric RN with Utilization Management experience, with hours from 12:00 PM to 8:30 PM EST and a competitive