Remote Behavioral Health Utilization Clinician

CVS Health; Maryland City (MD); Remote; USD 54,000 - 117,000; Full time

Job summary

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a fully remote role. You will review behavioral health authorizations and clinical documentation to determine medical necessity and appropriate levels of care, with a focus on inpatient mental health, detox, and substance use rehabilitation programs.

Requirements include an active, unrestricted Master’s-level Behavioral Health license or RN with psychiatric experience, 1+ year UM/UR experience, and 3+

Qualifications

• Licensed Behavioral Health professional with a Master’s level license in the state of residence (LMSW, LCSW, LISW, LPC or equivalent)
• Or an active, unrestricted 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
• Availability for the 12:00 PM – 8:30 PM EST shift
• Strong clinical decision-making and medical necessity review skills

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and levels of care
• Apply evidence-based behavioral health guidelines to authorization decisions
• Utilize Medicare coverage criteria where applicable
• Document determinations, rationale and recommendations clearly
• 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 improve quality and reduce denials

Skills

Clinical decision-making

Medical necessity review

Utilization Management

Education

Master's degree in Behavioral Health

ADN with Behavioral Health experience

BSN preferred

Tools

EMR systems

Job description

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a fully remote role. You will review behavioral health authorizations and clinical documentation to determine medical necessity and appropriate levels of care, with a focus on inpatient mental health, detox, and substance use rehabilitation programs.

Requirements include an active, unrestricted Master’s-level Behavioral Health license or RN with psychiatric experience, 1+ year UM/UR experience, and 3+