Remote Behavioral Health Utilization Clinician

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

Benefits offered by this job

Fully remote

Weekday schedule

Bonus eligibility

Job summary

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a fully remote, weekday schedule. The role focuses on reviewing behavioral health authorizations and ensuring appropriate levels of care, with opportunities to impact access to treatment across inpatient and rehab services.

The ideal candidate will have a Master’s in Behavioral Health or an RN with behavioral health experience, and demonstrate strong clinical decision-making and documentation skills.

Qualifications

• Active, unrestricted Master’s-level Behavioral Health license in resident state (e.g., LMSW, LCSW, LISW, LPC or equivalent).
• OR active, unrestricted RN license with psychiatric/behavioral health experience.

Responsibilities

• Review behavioral health authorization requests and clinical docs to determine medical necessity and levels of care.
• Apply evidence-based guidelines and Medicare criteria when applicable.
• Coordinate with facilities/providers to obtain additional information as needed.
• Support discharge planning and transitions of care; communicate decisions to stakeholders.
• Identify patients who may benefit from additional clinical programs or care management.

Skills

Behavioral health review

Clinical decision making

Medical necessity assessment

Documentation accuracy

Communication with providers

Education

Master's in Behavioral Health

ADN in Nursing (for RN option)

Tools

Healthcare guidelines

CRMs/electronic records

Job description

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a fully remote, weekday schedule. The role focuses on reviewing behavioral health authorizations and ensuring appropriate levels of care, with opportunities to impact access to treatment across inpatient and rehab services.

The ideal candidate will have a Master’s in Behavioral Health or an RN with behavioral health experience, and demonstrate strong clinical decision-making and documentation skills.