Remote Behavioral Health UM Clinician - Precertification

CVS Health; Massachusetts; Remote; USD 54.000 - 117.000; Vollzeit

Benefits dieser Stelle

Fully remote opportunity

Consistent weekday schedule

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Bonus eligibility

Zusammenfassung

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests, assess medical necessity and determine appropriate levels of care for behavioral health services.

This 100% remote, weekday role focuses on inpatient mental health, detoxification, and substance use programs, with hours 12:00 PM–8:30 PM EST. Requires a Master's license or psychiatric RN with UM experience.

Qualifikationen

• Active, unrestricted Master's-level Behavioral Health license in home state (LMSW/LCSW/LISW/LPC).
• OR active RN license with psychiatric/behavioral health experience.
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience.
• 3+ years inpatient behavioral health experience in a hospital setting.
• Ability to work 12:00 PM – 8:30 PM EST.
• Strong clinical decision-making and medical necessity review skills.

Aufgaben

• 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 and requirements when applicable.
• Document determinations, rationale, and recommendations thoroughly.
• 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 members who may benefit from additional clinical programs or care management.
• Participate in crisis queue coverage, including member triage and documentation.
• Identify opportunities to improve quality and reduce denials.

Kenntnisse

Behavioral Health license

Utilization Management experience

Inpatient behavioral health experience

Psychiatric RN experience

Ausbildung

Master's degree in Social Work / Counseling / Psychology

ADN with Behavioral Health experience

BSN

Jobbeschreibung

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests, assess medical necessity and determine appropriate levels of care for behavioral health services.

This 100% remote, weekday role focuses on inpatient mental health, detoxification, and substance use programs, with hours 12:00 PM–8:30 PM EST. Requires a Master's license or psychiatric RN with UM experience.