Remote Behavioral Health Utilization Clinician

CVS Health; Milton (MA); 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 100% remote role nationwide. You will review preauthorization requests, apply evidence-based guidelines, and coordinate decisions with providers to ensure timely, appropriate care.

Qualified candidates hold an active behavioral health license, 3+ years of post-licensure experience in mental health or SUD, and can manage crisis calls and telephonic work while delivering quality, cost-effective services.

Qualifications

• Active, unrestricted behavioral health license in your state.
• LPC, LMHC, or LCMHC eligibility.
• RN license with behavioral health emphasis is acceptable.
• 3+ years post-licensure behavioral health experience.
• 3+ years 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.

Responsibilities

• Review preauthorization requests for behavioral health services using guidelines and clinical judgment.
• Coordinate, document, and communicate utilization management decisions with providers and stakeholders.
• Manage crisis calls and assess risk, escalating for suicide risk or welfare checks when necessary.
• Apply clinical expertise to support quality and cost-effective care.
• Work in a fast-paced, queue-based environment while managing priorities.
• Collaborate with providers and care teams to facilitate appropriate levels of care.

Skills

Crisis management

Clinical judgment

Care coordination

Telephonic work

Documentation

Provider communication

Time management

Education

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

Bachelor's degree in Nursing with behavioral health emphasis

Job description

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a 100% remote role nationwide. You will review preauthorization requests, apply evidence-based guidelines, and coordinate decisions with providers to ensure timely, appropriate care.

Qualified candidates hold an active behavioral health license, 3+ years of post-licensure experience in mental health or SUD, and can manage crisis calls and telephonic work while delivering quality, cost-effective services.