Remote Behavioral Health Utilization Clinician

CVS Health; Alabama; Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Full benefits package

Fully remote

Competitive pay

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote, weekday role (12:00 PM–8:30 PM EST). The position reviews authorization requests to ensure medical necessity and appropriate levels of care, with emphasis on inpatient mental health, detox, and substance use programs.

The role requires a Master’s-level Behavioral Health license or an RN with psychiatric experience, plus 1+ year in Utilization Review/UM and 3+ years inpatient behavioral health.

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence (e.g., 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; 3+ years inpatient behavioral health experience.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and level of care.
• Apply evidence-based guidelines and Medicare criteria where applicable.
• Document determinations, rationale, and recommendations thoroughly.
• Coordinate with facilities/providers to obtain additional information and support discharge planning.

Skills

Utilization Management

Behavioral Health

Clinical decision-making

Education

Master's Behavioral Health license

RN with psychiatric/behavioral health experience

BSN preferred

Tools

EMR systems

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote, weekday role (12:00 PM–8:30 PM EST). The position reviews authorization requests to ensure medical necessity and appropriate levels of care, with emphasis on inpatient mental health, detox, and substance use programs.

The role requires a Master’s-level Behavioral Health license or an RN with psychiatric experience, plus 1+ year in Utilization Review/UM and 3+ years inpatient behavioral health.