Remote Behavioral Health Utilization Clinician

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

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests, determine medical necessity, and ensure appropriate levels of care for behavioral health services. This fully remote role offers a weekday schedule (12:00 PM–8:30 PM EST) and the chance to impact access to care for diverse populations while collaborating with facilities and providers.

Qualifications include an active behavioral health license or psychiatric RN, and experience in utilization

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in residence state (LMSW/LCSW/LISW/LPC or equivalent).
• 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.
• Ability to work the scheduled hours 12:00 PM – 8:30 PM EST.
• Strong clinical decision-making and medical necessity review skills.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and level of care.
• Apply evidence-based behavioral health guidelines to authorization decisions.
• Utilize Medicare/Medicaid criteria when applicable.
• Document determinations, rationale and recommendations clearly.
• Coordinate with facilities and providers to obtain additional information as needed.
• Support discharge planning and transitions of care.
• Communicate authorization decisions to providers and internal stakeholders.
• Identify opportunities to improve quality and reduce denials.

Skills

BH licensure

RN license

Utilization Management

Inpatient BH experience

Clinical decision making

Education

Master's in Behavioral Health

ADN with BH experience

BSN preferred

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests, determine medical necessity, and ensure appropriate levels of care for behavioral health services. This fully remote role offers a weekday schedule (12:00 PM–8:30 PM EST) and the chance to impact access to care for diverse populations while collaborating with facilities and providers.

Qualifications include an active behavioral health license or psychiatric RN, and experience in utilization