Remote Behavioral Health Utilization Clinician

CVS Health; Accident (AR); Remote; USD 54.000 - 117.000; Vollzeit

Zusammenfassung

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a fully remote role. You will review authorization requests, determine medical necessity, and apply guidelines to ensure appropriate levels of care for behavioral health services.

The position requires a Master's-level behavioral health license or an RN with psychiatric/behavioral health experience, plus 1+ year in utilization management and 3+ years in inpatient behavioral health.

Qualifikationen

• Active, unrestricted Master’s-level Behavioral Health license in the state of residence (LMSW, LCSW, LISW, LPC or equivalent).
• Or active, unrestricted Registered Nurse (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.
• Ability to work the scheduled hours 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 to authorization decisions.
• 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 opportunities to improve quality, reduce denials, and optimize benefit utilization.
• Participate in crisis queue coverage, including member triage, call handling, escalation, and documentation.

Kenntnisse

Utilization management

Behavioral health assessment

Clinical decision-making

Crisis queue handling

Documentation

Ausbildung

Master's degree in Behavioral Health fields

RN license (psychiatric/behavioral health)

Jobbeschreibung

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a fully remote role. You will review authorization requests, determine medical necessity, and apply guidelines to ensure appropriate levels of care for behavioral health services.

The position requires a Master's-level behavioral health license or an RN with psychiatric/behavioral health experience, plus 1+ year in utilization management and 3+ years in inpatient behavioral health.