Remote Behavioral Health Utilization Clinician

CVS Health Corporation; Las Vegas (NV); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation seeks a Behavioral Health Precertification/Utilization Management Clinician for a 100% remote role supporting weekday scheduling. Focus areas include reviewing inpatient mental health, detox, and substance use rehabilitation cases to determine medical necessity.

The role requires a Master’s-level behavioral health license (or RN with psychiatric experience) and 1+ year in utilization management, along with 3+ years in inpatient behavioral health. Competitive benefits apply.

Qualifications

• Active, unrestricted Master’s-level Behavioral Health license in the state of residence or 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.

Responsibilities

• Review behavioral health authorization requests to determine medical necessity and level of care.
• Apply evidence-based guidelines and clinical standards to decisions.
• Coordinate with facilities and providers to obtain additional clinical information.
• Support discharge planning and transitions of care.
• Communicate authorization decisions to providers and internal stakeholders.
• Identify opportunities to reduce denials and optimize benefits.
• Participate in crisis queue coverage and member triage.

Education

Master’s Degree in Social Work, Counseling, Psychology

ADN nursing degree with behavioral health experience

BSN preferred

Job description

CVS Health Corporation seeks a Behavioral Health Precertification/Utilization Management Clinician for a 100% remote role supporting weekday scheduling. Focus areas include reviewing inpatient mental health, detox, and substance use rehabilitation cases to determine medical necessity.

The role requires a Master’s-level behavioral health license (or RN with psychiatric experience) and 1+ year in utilization management, along with 3+ years in inpatient behavioral health. Competitive benefits apply.