Remote Behavioral Health UM Clinician

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

Benefits offered by this job

Fully remote

Weekday schedule

Comprehensive benefits

Job summary

CVS Health in the United States is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests, determine medical necessity, and ensure appropriate levels of care for behavioral health services.

This 100% remote, weekday role offers a consistent schedule (12:00 PM–8:30 PM EST) and a comprehensive benefits package. Qualified candidates will have a Master's in Behavioral Health and relevant utilization management experience, with opportunities to impact patient care.

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.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to evaluate medical necessity.
• Apply evidence-based guidelines and clinical standards to authorization decisions.
• Coordinate with facilities and providers to obtain additional information.
• Document determinations, rationale, and recommendations clearly.
• Support discharge planning and transitions of care.
• Communicate decisions to providers and internal stakeholders.

Skills

Utilization review

Clinical judgment

Documentation

Communication

Education

Master's in Behavioral Health (MSW/LCSW/LISW/LPC or equivalent)

ADN with Behavioral Health experience

BSN (preferred)

Job description

CVS Health in the United States is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests, determine medical necessity, and ensure appropriate levels of care for behavioral health services.

This 100% remote, weekday role offers a consistent schedule (12:00 PM–8:30 PM EST) and a comprehensive benefits package. Qualified candidates will have a Master's in Behavioral Health and relevant utilization management experience, with opportunities to impact patient care.