Remote Behavioral Health Utilization Clinician

CVS Health; Florida; Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Fully remote opportunity

Competitive benefits package

Bonus program

Job summary

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician to review authorization requests and determine medical necessity for behavioral health services. This fully remote role emphasizes evidence-based care and timely decisions.

The position requires active Behavioral Health licensure or an RN with psychiatric experience, plus 1+ year of utilization management and 3+ years in inpatient behavioral health. Hours are 12:00 PM – 8:30 PM EST, Monday through Friday.

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence (e.g., LMSW, LCSW, LISW, LPC or equivalent).
• 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.
• Strong clinical decision-making and medical necessity review skills.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to evaluate medical necessity and levels of care.
• Apply evidence-based behavioral health guidelines and Medicare criteria where applicable.
• Document determinations, rationale, and recommendations accurately.
• Coordinate with facilities and providers to obtain additional information when needed.
• Support discharge planning and transitions of care.
• Communicate authorization decisions to providers and internal stakeholders.
• Participate in crisis queue coverage and member triage.

Skills

Clinical decision making

Utilization Management experience

Inpatient behavioral health experience

Communication skills

Education

Master's degree in Behavioral Health

ADN with Behavioral Health experience

BSN preferred

Job description

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician to review authorization requests and determine medical necessity for behavioral health services. This fully remote role emphasizes evidence-based care and timely decisions.

The position requires active Behavioral Health licensure or an RN with psychiatric experience, plus 1+ year of utilization management and 3+ years in inpatient behavioral health. Hours are 12:00 PM – 8:30 PM EST, Monday through Friday.