Remote Behavioral Health Utilization Clinician

CVS Health; Crystal Bay (NV); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Remote work

Bonus eligibility

Comprehensive benefits

Job summary

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a fully remote role. You will review authorization requests, apply guidelines, and coordinate with facilities to ensure appropriate levels of care for behavioral health patients.

The position requires a Master's-level Behavioral Health license or an RN with psychiatric/behavioral health experience, and 1+ year UM experience, plus 3+ years inpatient behavioral health in a hospital setting.

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence.
• Active, unrestricted 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.
• Ability to work the scheduled hours 12:00 PM – 8:30 PM EST.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and level of care.
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions.
• Utilize Medicare coverage criteria and requirements when applicable.
• 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.
• Communicate authorization decisions and next steps to providers and internal stakeholders.
• Identify members who may benefit from additional clinical programs and care management support.
• Participate in crisis queue coverage, including member triage, call handling, escalation, and documentation.
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization.

Skills

Utilization Management experience

Clinical decision making

Behavioral health assessments

Education

Master's degree in Behavioral Health

Associate Degree in Nursing (ADN) with Behavioral Health experience

BSN (Preferred)

Job description

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a fully remote role. You will review authorization requests, apply guidelines, and coordinate with facilities to ensure appropriate levels of care for behavioral health patients.

The position requires a Master's-level Behavioral Health license or an RN with psychiatric/behavioral health experience, and 1+ year UM experience, plus 3+ years inpatient behavioral health in a hospital setting.