Remote Behavioral Health Utilization Clinician

CVS Health; Bastrop (LA); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Fully remote opportunity

Weekday schedule

Comprehensive benefits

Bonus eligibility

Job summary

CVS Health is hiring a Behavioral Health Precertification / Utilization Management Clinician for a 100% remote role with a Monday–Friday, 12:00 PM – 8:30 PM EST schedule. The role reviews authorization requests for behavioral health services, ensuring appropriate levels of care and timely, evidence-based treatment for members.

Responsibilities include reviewing assessments and plans, applying guidelines, documenting decisions, coordinating with facilities, and supporting transitions of care.

Qualifications

• Licensed Behavioral Health professional or Psychiatric RN with Utilization Management experience.
• Master's level Behavioral Health licensure required.
• Inpatient behavioral health experience in a hospital setting preferred.

Responsibilities

• Review behavioral health assessments, treatment plans, progress notes and clinical documentation to evaluate medical necessity.
• Apply evidence-based behavioral health guidelines and clinical standards to authorization decisions.
• Document determinations, rationale, and recommendations accurately.
• Coordinate with facilities and providers to obtain additional information when needed.
• Support discharge planning and transitions of care; identify opportunities to improve quality and reduce denials.

Skills

Behavioral Health

Clinical decision-making

Medical necessity review

Documentation

Education

Master's degree in Behavioral Health (SW/ Counseling/ Psychology)

RN license with psychiatric/behavioral health experience (ADN/BSN)

LPC license (where applicable)

Job description

CVS Health is hiring a Behavioral Health Precertification / Utilization Management Clinician for a 100% remote role with a Monday–Friday, 12:00 PM – 8:30 PM EST schedule. The role reviews authorization requests for behavioral health services, ensuring appropriate levels of care and timely, evidence-based treatment for members.

Responsibilities include reviewing assessments and plans, applying guidelines, documenting decisions, coordinating with facilities, and supporting transitions of care.