Remote Behavioral Health Utilization Clinician

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

Benefits offered by this job

Comprehensive benefits package

Fully remote opportunity

Weekday-only schedule

Job summary

CVS Health in the United States is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role. You will review authorization requests, determine medical necessity, and ensure appropriate levels of care, with a focus on inpatient mental health, detox, and substance use programs.

The role emphasizes evidence-based decision-making and collaboration with facilities. Ideal candidates have a Master’s in Behavioral Health and UM experience, plus RN licensure or a master’s-level

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence (LMSW/LCSW/LISW/LPC or equivalent).
• OR 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 documentation to determine medical necessity and level of care.
• Apply evidence-based guidelines and Medicare criteria when applicable.
• Document determinations and rationale clearly.
• Coordinate with facilities/providers to obtain additional information.
• Support discharge planning and transitions of care.
• Communicate decisions to providers and internal stakeholders.
• Participate in crisis queue coverage and member triage.

Skills

Behavioral Health UR

Utilization Management

Clinical decision-making

Evidence-based guidelines

Education

Master's degree in Social Work / Counseling / Psychology

ADN with Behavioral Health experience

BSN

Tools

EHR systems

Job description

CVS Health in the United States is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role. You will review authorization requests, determine medical necessity, and ensure appropriate levels of care, with a focus on inpatient mental health, detox, and substance use programs.

The role emphasizes evidence-based decision-making and collaboration with facilities. Ideal candidates have a Master’s in Behavioral Health and UM experience, plus RN licensure or a master’s-level