Remote Behavioral Health UM Clinician (Full-Time)

CVS Health; Hydaburg (AK); À distance; USD 54 000 - 117 000; Plein temps

Avantages offerts par ce poste

Fully remote

Comprehensive benefits

Bonus program

Remote-friendly schedule

Résumé du poste

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role. Shifts are Mon-Fri, 12:00 PM–8:30 PM EST.

You will review behavioral health authorization requests, assess medical necessity, and determine appropriate levels of care across inpatient mental health, detoxification, and substance use rehabilitation programs. The role requires an active Master’s-level Behavioral Health license or an unrestricted RN license with psychiatric/behavioral health experience,

Qualifications

• Active, unrestricted Master's-level Behavioral Health license (LMSW/LCSW/LISW/LPC) in state of residence.
• 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.
• Strong clinical decision-making and medical necessity review skills.

Responsabilités

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and level of care.
• Apply evidence-based behavioral health guidelines and clinical practice standards to decisions.
• Utilize Medicare coverage criteria when applicable and document determinations clearly.
• Coordinate with facilities/providers to obtain additional information as needed.
• Support discharge planning and transitions of care; communicate decisions to providers and stakeholders.
• Identify opportunities to reduce denials and improve benefit utilization; participate in crisis queue coverage.

Connaissances

Clinical decision-making

Medical necessity review

Crisis queue management

Documentation & communication

Formation

Master's Degree in Behavioral Health

LMSW/LCSW/LISW/LPC or RN psychiatric license

RN with psychiatric/behavioral health experience

ADN with Behavioral Health experience

Description du poste

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role. Shifts are Mon-Fri, 12:00 PM–8:30 PM EST.

You will review behavioral health authorization requests, assess medical necessity, and determine appropriate levels of care across inpatient mental health, detoxification, and substance use rehabilitation programs. The role requires an active Master’s-level Behavioral Health license or an unrestricted RN license with psychiatric/behavioral health experience,