Remote Behavioral Health Utilization Clinician

CVS Health; East Honolulu (HI); Remoto; USD 54.000 - 117.000; Tempo pieno

Descrizione del lavoro

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests and clinical documentation for medical necessity and appropriate levels of care. The role focuses on inpatient mental health and substance use programs, with a strong emphasis on evidence‑based guidelines and high‑quality documentation.

The position is fully remote with a consistent Mon‑Fri schedule (12:00 PM–8:30 PM EST).

Competenze

• Active, unrestricted Master’s‑level Behavioral Health license in the state of residence
• 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

Mansioni

• 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, services, or care management support
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization

Conoscenze

Utilization Review experience

Medical necessity evaluation

Clinical decision‑making

Documentation and record‑keeping

Formazione

Master's Degree in Behavioral Health

Descrizione del lavoro

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests and clinical documentation for medical necessity and appropriate levels of care. The role focuses on inpatient mental health and substance use programs, with a strong emphasis on evidence‑based guidelines and high‑quality documentation.

The position is fully remote with a consistent Mon‑Fri schedule (12:00 PM–8:30 PM EST).