Remote Behavioral Health Utilization Clinician

CVS Health; Clayton (NC); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Comprehensive benefits package

Remote work

Job summary

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a fully remote, weekday schedule. You will review authorization requests, assess medical necessity, and determine appropriate levels of care for inpatient mental health and substance use programs.

The role requires an active Behavioral Health license in the state of residence, 1+ year UM experience, and ~3+ years inpatient behavioral health experience, with strong documentation and decision-making

Qualifications

• Active, unrestricted Behavioral Health license in the state of residence
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience
• Approximately 3+ years of inpatient behavioral health experience in a hospital setting
• Strong clinical decision-making and medical necessity review skills
• Ability to work remotely and adhere to a consistent weekday schedule

Responsibilities

• 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 accurately and thoroughly
• Coordinate with facilities and providers to obtain additional clinical information when needed
• Support discharge planning and transitions of care
• Identify members who may benefit from additional clinical programs or care management
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization

Skills

Clinical decision-making

Medical necessity review

Documentation skills

Typing speed

Education

Master's degree in Behavioral Health

RN with BH experience (ADN/BSN)

Tools

Electronic Health Records (EHR) experience

Job description

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a fully remote, weekday schedule. You will review authorization requests, assess medical necessity, and determine appropriate levels of care for inpatient mental health and substance use programs.

The role requires an active Behavioral Health license in the state of residence, 1+ year UM experience, and ~3+ years inpatient behavioral health experience, with strong documentation and decision-making