Remote Behavioral Health UM Clinician (Precertification)

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

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote, weekday position (Mon-Fri, 12:00 PM - 8:30 PM EST). You will review behavioral health authorization requests, apply guidelines, and coordinate with providers to ensure appropriate care and timely treatment.

The role requires an active behavioral health license or an RN with psychiatric BH experience, with 1+ year in Utilization Management and 3+ years inpatient BH experience.

Qualifications

• Active, unrestricted Master’s-level Behavioral Health license in the state of residence (e.g., LMSW, LCSW, LISW, LPC)
• Active, unrestricted RN 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 of 12:00 PM - 8:30 PM EST

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate level of care
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions
• Utilize Medicare coverage criteria when applicable
• Document determinations, rationale and recommendations
• Coordinate with facilities and providers to obtain additional clinical information
• 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 and case triage
• Identify opportunities to reduce denials and improve care utilization

Skills

Behavioral health license

RN license with BH experience

Utilization Management experience

Education

Master's Degree in Social Work/Counseling/Psychology

ADN with BH experience

BSN (preferred)

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote, weekday position (Mon-Fri, 12:00 PM - 8:30 PM EST). You will review behavioral health authorization requests, apply guidelines, and coordinate with providers to ensure appropriate care and timely treatment.

The role requires an active behavioral health license or an RN with psychiatric BH experience, with 1+ year in Utilization Management and 3+ years inpatient BH experience.