Remote Behavioral Health UM Clinician – Precertification

CVS Health; Athens (GA); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus eligibility

Remote work

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests, determine medical necessity, and ensure appropriate levels of care for behavioral health patients. This remote role follows a weekday schedule with EST hours and offers a comprehensive benefits package.

The position emphasizes applying evidence-based guidelines, documenting decisions, coordinating with facilities, and supporting transitions of care.

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in state of residence.
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience.
• Approximately 3+ years inpatient behavioral health experience in a hospital setting.
• Strong clinical decision-making and medical necessity review skills.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate levels of care.
• Apply evidence-based guidelines and clinical practice standards to authorization decisions.
• Document determinations, rationale, and recommendations clearly.
• Coordinate with facilities and providers to obtain additional information when needed.
• Support discharge planning and transitions of care.
• Identify members who may benefit from additional programs or care management.
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization.

Skills

Clinical decision making

Medical necessity review

Typing / keyboarding

Education

Master's degree in Behavioral Health

RN: ADN or BSN (per role)

MSW / Counseling / Psychology degree

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests, determine medical necessity, and ensure appropriate levels of care for behavioral health patients. This remote role follows a weekday schedule with EST hours and offers a comprehensive benefits package.

The position emphasizes applying evidence-based guidelines, documenting decisions, coordinating with facilities, and supporting transitions of care.