Remote Behavioral Health Utilization Clinician

CVS Health; Fulton (MS); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Fully remote

Weekday schedule

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests, determine medical necessity, and ensure appropriate levels of care for behavioral health services. This 100% remote, full-time role supports inpatient mental health, substance use programs, and transitions of care.

Candidates must hold an active, unrestricted Master's-level Behavioral Health license in their state, have 1+ year of utilization review experience, about 3 years inpatient

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence.
• 1+ year of Behavioral Health Utilization Review or Utilization Management experience.
• Approximately 3+ years inpatient Behavioral Health experience in a hospital setting.
• Recent Behavioral Health-focused work history and strong clinical decision-making.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and 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.

Skills

Utilization Review

Medical Necessity

Clinical Decision-Making

Documentation

Medicare Guidelines

Typing

Education

Master's Degree in Behavioral Health

ADN (Nursing, Behavioral Health experience)

BSN (Nursing, Behavioral Health experience)

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests, determine medical necessity, and ensure appropriate levels of care for behavioral health services. This 100% remote, full-time role supports inpatient mental health, substance use programs, and transitions of care.

Candidates must hold an active, unrestricted Master's-level Behavioral Health license in their state, have 1+ year of utilization review experience, about 3 years inpatient