Remote Behavioral Health Utilization Clinician

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

Benefits offered by this job

Fully remote opportunity

Great benefits for great people

Consistent weekday schedule

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role with a 12:00 PM–8:30 PM EST schedule. You will review behavioral health authorization requests, ensuring medical necessity and appropriate levels of care across inpatient mental health, detox, and rehab programs.

The ideal candidate holds an unrestricted master's-level Behavioral Health license or an RN with psychiatric/behavioral health experience, plus U/M experience and inpatient BH background.

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence (LMSW, LCSW, LISW, LPC, or equivalent).
• Active, unrestricted Registered Nurse (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.
• Scheduled hours 12:00 PM – 8:30 PM EST.
• Strong clinical decision-making and medical necessity review skills.

Responsibilities

• Review behavioral health assessments, treatment plans, progress notes, and clinical documentation to evaluate medical necessity
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions
• Utilize Medicare coverage criteria and requirements when applicable
• 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
• Communicate authorization decisions and next steps to providers and internal stakeholders
• Identify members who may benefit from additional clinical programs, services, or care management support
• Participate in crisis queue coverage, including member triage, call handling, escalation, and documentation
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization

Skills

Behavioral health assessment

Medical necessity review

Clinical documentation

Discharge planning coordination

Education

Master's degree in Behavioral Health (e.g., Social Work, Counseling, Psychology)

Associate Degree in Nursing (ADN) with Behavioral Health experience

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role with a 12:00 PM–8:30 PM EST schedule. You will review behavioral health authorization requests, ensuring medical necessity and appropriate levels of care across inpatient mental health, detox, and rehab programs.

The ideal candidate holds an unrestricted master's-level Behavioral Health license or an RN with psychiatric/behavioral health experience, plus U/M experience and inpatient BH background.