Remote Behavioral Health Utilization Clinician

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

Benefits offered by this job

Fully remote

Benefits package

Paid time off

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role with a Monday–Friday 12:00 PM–8:30 PM EST schedule. The position reviews behavioral health authorization requests, applies guidelines, and ensures timely, evidence-based care decisions for inpatient mental health, detox, and substance use programs.

Required are a Master’s-level behavioral health license or an RN license with psychiatric experience, plus 1+ year UM experience and 3+ years inpatient

Qualifications

• Active, unrestricted Master’s-level Behavioral Health license in the state of residence (e.g., LMSW, LCSW, LISW, LPC) or equivalent independent clinical license.
• Active, unrestricted RN license with psychiatric/behavioral health experience.
• 1+ year Behavioral Health Utilization Review or UM experience.
• 3+ years inpatient behavioral health experience in a hospital setting.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate levels of care.
• Apply evidence-based behavioral health guidelines and practice standards to authorization decisions.
• Coordinate with facilities and providers to obtain additional clinical information when needed.
• Support discharge planning and transitions of care.

Skills

Behavioral Health Utilization Review

Utilization Management

Clinical decision-making

Education

Master's degree in Behavioral Health field

RN license (psychiatric/behavioral health)

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role with a Monday–Friday 12:00 PM–8:30 PM EST schedule. The position reviews behavioral health authorization requests, applies guidelines, and ensures timely, evidence-based care decisions for inpatient mental health, detox, and substance use programs.

Required are a Master’s-level behavioral health license or an RN license with psychiatric experience, plus 1+ year UM experience and 3+ years inpatient