Remote Behavioral Health Utilization Clinician

CVS Health; Butlerville (IN); Remoto; USD 54.000 - 117.000; Tempo pieno

Vantaggi offerti da questo lavoro

Fully remote

Comprehensive benefits

Bonus eligibility

Descrizione del lavoro

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role with a Monday–Friday schedule from 12:00 PM to 8:30 PM EST. The position focuses on reviewing behavioral health authorizations, determining medical necessity, and ensuring appropriate levels of care for members.

Required: active Master’s-level Behavioral Health license (e.g., LMSW/LCSW/LISW/LPC) or an RN with psychiatric/behavioral health experience; 1+ year in UM/UR and 3+ years inpatient behavioral

Competenze

• Active, unrestricted Master’s-level Behavioral Health license in the state of residence (e.g., LMSW, LCSW, LISW, LPC) or equivalent independent clinical license.
• 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.

Mansioni

• Review behavioral health authorization requests and clinical documentation to evaluate medical necessity and appropriate levels of care.
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions.
• Coordinate with facilities and providers to obtain additional clinical information as needed.
• Document determinations, rationale, and recommendations clearly.
• Support discharge planning and transitions of care; communicate decisions to providers and internal stakeholders.

Conoscenze

Behavioral Health License

Utilization Management

Inpatient Behavioral Health

Psychiatric RN

Formazione

MSW / LCSW / LISW / LPC or equivalent

RN with psychiatric/behavioral health experience

BSN preferred

Descrizione del lavoro

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role with a Monday–Friday schedule from 12:00 PM to 8:30 PM EST. The position focuses on reviewing behavioral health authorizations, determining medical necessity, and ensuring appropriate levels of care for members.

Required: active Master’s-level Behavioral Health license (e.g., LMSW/LCSW/LISW/LPC) or an RN with psychiatric/behavioral health experience; 1+ year in UM/UR and 3+ years inpatient behavioral