Remote Behavioral Health Utilization Clinician

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

Benefits offered by this job

Fully remote

Competitive benefits

Bonus eligibility

Job summary

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a fully remote, weekday schedule (12:00 PM – 8:30 PM EST). The role reviews authorization requests, applies guidelines, and supports appropriate levels of care for inpatient, detox, and rehab services.

Candidates should have an active behavioral health license (or psychiatric RN) and 1+ year in Utilization Management, plus 3+ years in inpatient behavioral health.

Qualifications

• Active, unrestricted Master’s-level Behavioral Health license in the state of residence or an RN license with 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 and Medicare criteria when applicable.
• Document determinations, rationale, and recommendations thoroughly.
• Coordinate with facilities/providers to obtain additional information.
• Support discharge planning and transitions of care.
• Communicate decisions to providers and internal stakeholders.
• Identify patients who may benefit from additional programs and care management.
• Participate in crisis queue coverage and member triage as needed.

Skills

Behavioral Health license

RN license (psychiatric)

Utilization Management

Inpatient behavioral health

Clinical documentation

Education

MSW/LCSW/LISW/LPC (Master’s level)

RN with behavioral health experience

ADN

BSN (preferred)

Job description

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a fully remote, weekday schedule (12:00 PM – 8:30 PM EST). The role reviews authorization requests, applies guidelines, and supports appropriate levels of care for inpatient, detox, and rehab services.

Candidates should have an active behavioral health license (or psychiatric RN) and 1+ year in Utilization Management, plus 3+ years in inpatient behavioral health.