Remote Behavioral Health Utilization Clinician

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

Benefits offered by this job

Fully remote position

Comprehensive benefits

Job summary

CVS Health seeks a Behavioral Health Precertification/UM Clinician to review authorization requests and determine medical necessity for behavioral health services. Focus areas include inpatient mental health, detox, and substance use rehab programs.

The role is 100% remote with a Monday–Friday 12:00 PM–8:30 PM EST schedule, offering collaboration with interdisciplinary teams to ensure timely, evidence-based care for members.

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in home state (e.g., LMSW/LCSW/LISW/LPC or equivalent).
• Or active, unrestricted RN license with psychiatric/behavioral health experience.
• 1+ year in Behavioral Health Utilization Review or Utilization Management.
• 3+ years inpatient behavioral health experience in a hospital setting.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity.
• Apply evidence-based guidelines and Medicare criteria when applicable.
• Document determinations, rationale, and recommendations clearly.
• Coordinate with facilities and providers to obtain additional information as needed.
• Support discharge planning and transitions of care; communicate decisions to providers.
• Assist in crisis queue coverage, triage, and documentation.
• Identify opportunities to improve quality and reduce denials.

Skills

Utilization management

Clinical decision making

Behavioral health expertise

Communication skills

Education

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

RN license with psychiatric/behavioral health experience

BSN preferred

Job description

CVS Health seeks a Behavioral Health Precertification/UM Clinician to review authorization requests and determine medical necessity for behavioral health services. Focus areas include inpatient mental health, detox, and substance use rehab programs.

The role is 100% remote with a Monday–Friday 12:00 PM–8:30 PM EST schedule, offering collaboration with interdisciplinary teams to ensure timely, evidence-based care for members.