Remote Behavioral Health Utilization Clinician

CVS Health; Heber (UT); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Fully remote opportunity

Consistent weekday schedule

Comprehensive benefits package

Job summary

CVS Health is seeking a Behavioral Health Precertification Clinician to review authorization requests and determine medical necessity for inpatient and rehab services. This fully remote role follows a consistent weekday schedule with EST hours and emphasizes evidence-based care decisions.

You will assess clinical documentation, apply guidelines, coordinate with facilities, and support transitions of care, contributing to timely access to behavioral health treatment.

Qualifications

• Licensed behavioral health professional or Psychiatric RN with UM experience.
• Review authorization requests and determine medical necessity.
• Apply behavioral health guidelines and document decisions clearly.

Responsibilities

• Review inpatient mental health and substance use authorization requests.
• Evaluate clinical documentation for medical necessity and level of care.
• Coordinate with facilities to obtain needed information.
• Support discharge planning and transitions of care.
• Identify opportunities to improve quality and reduce denials.

Skills

Master's-level Behavioral Health licen

LPC

Utilization Review experience

Inpatient behavioral health experience

Clinical decision-making

Education

Master's Degree in Social Work, Counseling, Psychology, or related Behavioral Health field

Associate Degree in Nursing (ADN) with Behavioral Health experience

Bachelor of Science in Nursing (BSN)

Job description

CVS Health is seeking a Behavioral Health Precertification Clinician to review authorization requests and determine medical necessity for inpatient and rehab services. This fully remote role follows a consistent weekday schedule with EST hours and emphasizes evidence-based care decisions.

You will assess clinical documentation, apply guidelines, coordinate with facilities, and support transitions of care, contributing to timely access to behavioral health treatment.