Remote Behavioral Health UM Clinician (12–8:30 EST)

CVS Health; Clayton (MO); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Remote work

Benefits package

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote, full-time role. The position reviews behavioral health authorizations to determine medical necessity and appropriate levels of care, focusing on inpatient BH, detox, and rehabilitation programs.

The role requires a licensed BH clinician or psychiatric RN with UM experience and a weekday schedule. The incumbent will document decisions, apply guidelines, and coordinate with facilities to support discharge

Qualifications

• Active, unrestricted Master’s-level Behavioral Health license in the state of residence (e.g., LMSW, LCSW, LISW, LPC) or RN with psychiatric/behavioral health experience.
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience.
• 3+ years of inpatient behavioral health in a hospital setting.

Responsibilities

• Review BH authorization requests and clinical documentation to determine medical necessity and level of care.
• Apply evidence-based BH guidelines and Medicare criteria where applicable.
• Document determinations and rationale thoroughly.
• Coordinate with facilities to obtain additional information as needed.
• Support discharge planning and transitions of care and communicate decisions to providers.

Skills

BH License

RN License

UM Experience

Inpatient BH

Clinical Decision

Education

Master’s degree in Behavioral Health

BSN (preferred)

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote, full-time role. The position reviews behavioral health authorizations to determine medical necessity and appropriate levels of care, focusing on inpatient BH, detox, and rehabilitation programs.

The role requires a licensed BH clinician or psychiatric RN with UM experience and a weekday schedule. The incumbent will document decisions, apply guidelines, and coordinate with facilities to support discharge