Remote Behavioral Health Utilization Clinician

CVS Health; Beryl (WV); A distancia; USD 54.000 - 117.000; Jornada completa

Descripción de la vacante

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role, Monday–Friday, 12:00 PM–8:30 PM EST. Review authorization requests for inpatient mental health and substance use care, ensuring medical necessity and appropriate levels of care with a focus on timely, evidence-based decisions.

The role requires an active Master’s-level Behavioral Health license (e.g., LPC), 1+ year UM experience, and ~3+ years inpatient BH hospital experience, with strong

Formación

• Active, unrestricted Master's-level Behavioral Health license in the state of residence (e.g., LPC).
• 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 experience or continuous behavioral health-focused work history.
• Strong clinical decision-making and medical necessity review skills.
• Working knowledge of Medicare Behavioral Health guidelines.
• Excellent documentation and computer skills.

Responsabilidades

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate levels of care.
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions.
• Document determinations, rationale, and recommendations clearly.
• Coordinate with facilities and providers to obtain additional clinical information when needed.
• Support discharge planning and transitions of care; identify patients who may benefit from additional programs or care management.

Conocimientos

Utilization Management

Inpatient Behavioral Health

Clinical Decision-Making

Medical Necessity Review

Medicare Behavioral Health Guidelines

Documentation Proficiency

Computer Skills

Educación

Master's-level Behavioral Health license (e.g., LPC)

Master's Degree in Social Work, Counseling, Psychology, or related Behavioral Health discipline

Descripción del empleo

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role, Monday–Friday, 12:00 PM–8:30 PM EST. Review authorization requests for inpatient mental health and substance use care, ensuring medical necessity and appropriate levels of care with a focus on timely, evidence-based decisions.

The role requires an active Master’s-level Behavioral Health license (e.g., LPC), 1+ year UM experience, and ~3+ years inpatient BH hospital experience, with strong