Remote Behavioral Health Utilization Clinician

CVS Health; Eagle (ID); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Remote work

Competitive benefits

Paid time off

Job summary

CVS Health is hiring a Behavioral Health Precertification/UM Clinician to review authorization requests and ensure medical necessity for inpatient mental health, detox, and substance use programs. This fully remote role operates Monday–Friday 12:00 PM–8:30 PM EST, offering a meaningful opportunity to support members across settings.

You will apply evidence-based guidelines, coordinate with providers, and contribute to discharge planning while maintaining high documentation standards and

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence (e.g., LMSW, LCSW, LISW, LPC)
• 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
• Scheduled hours 12:00 PM – 8:30 PM EST
• Strong clinical decision-making and medical necessity review skills

Responsibilities

• Review behavioral health authorization requests and clinical documentation to evaluate medical necessity
• Apply evidence-based behavioral health guidelines to authorization decisions
• Coordinate with facilities and providers to obtain additional clinical information
• Support discharge planning and transitions of care
• Communicate authorization decisions to providers and internal stakeholders
• Identify members who may benefit from additional clinical programs

Skills

Clinical decision-making

Utilization management

Behavioral health assessments

Documentation skills

Education

Master's Degree in Social Work / Counseling / Psychology

ADN with Behavioral Health experience

BSN preferred

Job description

CVS Health is hiring a Behavioral Health Precertification/UM Clinician to review authorization requests and ensure medical necessity for inpatient mental health, detox, and substance use programs. This fully remote role operates Monday–Friday 12:00 PM–8:30 PM EST, offering a meaningful opportunity to support members across settings.

You will apply evidence-based guidelines, coordinate with providers, and contribute to discharge planning while maintaining high documentation standards and