Remote Behavioral Health UM Clinician - Precertification

CVS Health Corporation; United States; Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Fully remote

Weekday schedule

Utilization Mgmt role

Collaborative team

Job summary

CVS Health Corporation is seeking a Utilization Management Clinician Behavioral Health - Precertification for 100% remote work. You will review authorization requests for inpatient mental health, detox, and substance use programs, ensuring medical necessity and appropriate levels of care.

This full-time role requires an active master's-level behavioral health license or RN with psychiatric experience, 1+ year UM experience, 3+ years inpatient BH in a hospital setting, and the ability to work

Qualifications

• Review behavioral health authorization requests to evaluate medical necessity.
• Apply evidence-based guidelines and practice standards to decisions.
• Coordinate with facilities to obtain additional clinical information.
• Document determinations, rationale, and recommendations clearly.

Responsibilities

• Review behavioral health assessments, treatment plans, progress notes, and clinical documentation to evaluate medical necessity.
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions.
• Utilize Medicare coverage criteria and requirements when applicable.
• Document determinations, rationale, and recommendations accurately and thoroughly.
• Coordinate with facilities and providers to obtain additional clinical information when 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, services, or care management support.
• Participate in crisis queue coverage, including member triage, call handling, escalation, and documentation.
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization.

Skills

Behavioral health utilization review

Inpatient behavioral health experience

Clinical decision-making

Work schedule 12:00 PM - 8:30 PM EST

Education

Master's degree in Behavioral Health

ADN with Behavioral Health experience

BSN preferred

Job description

CVS Health Corporation is seeking a Utilization Management Clinician Behavioral Health - Precertification for 100% remote work. You will review authorization requests for inpatient mental health, detox, and substance use programs, ensuring medical necessity and appropriate levels of care.

This full-time role requires an active master's-level behavioral health license or RN with psychiatric experience, 1+ year UM experience, 3+ years inpatient BH in a hospital setting, and the ability to work