Remote Behavioral Health Utilization Clinician

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

Benefits offered by this job

Fully remote

Weekday schedule

Benefits package

Job summary

CVS Health is recruiting a Behavioral Health Precertification/Utilization Management Clinician for a 100% remote, weekday role. The position focuses on reviewing authorization requests, applying guidelines, and ensuring appropriate levels of care for behavioral health patients.

Licensure in behavioral health or a psychiatric RN with relevant UM experience is required, along with strong clinical decision-making. The role offers a full benefits package and remote work from the United States.

Qualifications

• Active, unrestricted behavioral health license in the state of residence or RN 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 12:00 PM – 8:30 PM EST.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to evaluate medical necessity.
• Apply evidence-based guidelines and Medicare requirements where applicable.
• Document determinations, rationale, and recommendations clearly.
• Coordinate with facilities and providers for additional information.
• Support discharge planning and transitions of care.

Skills

Behavioral Health

Utilization Management

Clinical Decision-Making

Education

Master's Degree in Social Work / Counseling / Psychology

RN license with Psychiatric/Behavioral Health experience

ADN/BSN with Behavioral Health experience

Job description

CVS Health is recruiting a Behavioral Health Precertification/Utilization Management Clinician for a 100% remote, weekday role. The position focuses on reviewing authorization requests, applying guidelines, and ensuring appropriate levels of care for behavioral health patients.

Licensure in behavioral health or a psychiatric RN with relevant UM experience is required, along with strong clinical decision-making. The role offers a full benefits package and remote work from the United States.