Remote Behavioral Health UM Clinician (Precertification)

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

Benefits offered by this job

Fully remote opportunity

Weekday schedule

Comprehensive benefits

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote, weekday schedule role. The position focuses on reviewing authorization requests, ensuring medical necessity and appropriate levels of care for inpatient mental health and substance use programs.

Applicants should have a Master’s in Behavioral Health and UM experience, with strong documentation, clinical decision-making, and collaboration with facilities and providers.

Qualifications

• Licensed Behavioral Health professional or Psychiatric RN with UM experience.
• Experience reviewing behavioral health authorization requests for medical necessity and levels of care.
• Knowledge of inpatient behavioral health and substance use programs.
• Familiarity with evidence-based behavioral health guidelines and documentation standards.

Responsibilities

• Review behavioral health authorization requests and related clinical documentation.
• Determine medical necessity and appropriate levels of care.
• Coordinate with facilities and providers to obtain additional information.
• Support discharge planning and transitions of care.
• Identify members who may benefit from additional programs or care management.
• Document determinations, rationale, and recommendations accurately.

Skills

Utilization Management experience

Clinical decision-making

Documentation skills

Education

Master's degree in Behavioral Health

ADN with Behavioral Health experience

BSN

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote, weekday schedule role. The position focuses on reviewing authorization requests, ensuring medical necessity and appropriate levels of care for inpatient mental health and substance use programs.

Applicants should have a Master’s in Behavioral Health and UM experience, with strong documentation, clinical decision-making, and collaboration with facilities and providers.