Remote Behavioral Health Utilization Clinician

CVS Health; Kansas; Remote; USD 54,000 - 143,000; Full time

Benefits offered by this job

Remote work

Shift differential 12.5%

Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a fully remote nationwide role. The position focuses on reviewing preauthorization requests, coordinating management decisions, and ensuring appropriate levels of care across providers and care teams.

A licensed behavioral health professional with 3+ years of post-licensure experience is required, along with strong telephonic and computer-based work capabilities and knowledge of utilization management processes.

Qualifications

• Active, unrestricted behavioral health license in residence state.
• LPC, LMHC, or LCMHC certification as applicable.
• RN with relevant behavioral health focus.
• 3+ years of post-licensure behavioral health experience.
• 3+ years of experience with mental health and substance use disorders.
• Ability to manage telephonic and computer-based work simultaneously.
• Hospital-based behavioral health experience.
• Utilization Management or Prior Authorization experience.
• Managed Care experience.
• Fully remote position available anywhere in the U.S.

Responsibilities

• Review preauthorization requests for behavioral health services.
• Coordinate, document, and communicate utilization management decisions with providers and stakeholders.
• Manage crisis calls and assess risk with interventions, including escalation for suicide risk, self-harm concerns, and welfare checks when necessary.
• Apply clinical expertise to support quality, cost-effective care and positive member outcomes.
• Work in a fast-paced, queue-based environment while managing multiple priorities.
• Collaborate with providers and care teams to facilitate appropriate levels of care.

Skills

Clinical judgment

Telephonic work

Multitasking

Education

Master's degree in Social Work, Counseling, or Psychology

RN with Behavioral Health emphasis

Tools

Electronic health records

Job description

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a fully remote nationwide role. The position focuses on reviewing preauthorization requests, coordinating management decisions, and ensuring appropriate levels of care across providers and care teams.

A licensed behavioral health professional with 3+ years of post-licensure experience is required, along with strong telephonic and computer-based work capabilities and knowledge of utilization management processes.