Remote Behavioral Health UM Clinician - Precertification

CVS Health; Louisiana; Hybrid; USD 54,000 - 117,000; Full time

Job summary

CVS Health is seeking a licensed Behavioral Health clinician or Psychiatric RN to join our Utilization Management team in a fully remote precertification role. You will review authorization requests, apply evidence-based guidelines, and ensure appropriate levels of care for inpatient mental health, detox, and rehab services, with a 12:00 PM–8:30 PM EST schedule.

This remote position emphasizes medical necessity reviews, collaboration with facilities and providers, and opportunities to impact

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence (LMSW, LCSW, LISW, LPC or equivalent).
• OR active, unrestricted Registered Nurse 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.
• Recent behavioral health-focused work history.
• 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 behavioral health guidelines and clinical practice standards to decisions.
• Utilize Medicare coverage criteria when applicable.
• Document determinations, rationale, and recommendations clearly.
• Coordinate with facilities and providers to obtain additional information as needed.
• Support discharge planning and transitions of care.
• Communicate authorization decisions and next steps to providers and internal stakeholders.
• Identify patients who may benefit from additional clinical programs or care management.
• Participate in crisis queue coverage, triage, and documentation.

Skills

Clinical decision-making

Medical necessity review

Documentation

Communication with providers

Education

Master's Degree in Behavioral Health

Associate Degree in Nursing (ADN)

BSN (preferred)

Job description

CVS Health is seeking a licensed Behavioral Health clinician or Psychiatric RN to join our Utilization Management team in a fully remote precertification role. You will review authorization requests, apply evidence-based guidelines, and ensure appropriate levels of care for inpatient mental health, detox, and rehab services, with a 12:00 PM–8:30 PM EST schedule.

This remote position emphasizes medical necessity reviews, collaboration with facilities and providers, and opportunities to impact