Remote Behavioral Health Utilization Clinician

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

Benefits offered by this job

Fully remote opportunity

Consistent weekday schedule

Specialized Behavioral Health Util UM

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role with a consistent Monday–Friday 12:00 PM – 8:30 PM EST schedule. The candidate will review behavioral health authorization requests, ensure appropriate levels of care, and apply evidence-based guidelines to determine medical necessity.

Responsibilities include coordinating with facilities, documenting determinations, and supporting discharge planning.

Qualifications

• Active, unrestricted Master’s-level Behavioral Health license in the state of residence (e.g., 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.
• 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 evaluate medical necessity and appropriate levels of care.
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions.
• Utilize Medicare coverage criteria when applicable and document determinations accurately.
• Coordinate with facilities and providers to obtain additional information; support discharge planning and transitions of care.
• Communicate authorization decisions to providers and internal stakeholders; identify cases for additional programs or care management.

Skills

Behavioral Health license

RN license

Utilization Management

Inpatient behavioral health

Clinical decision-making

Education

Master's degree in Behavioral Health

ADN (RN) with BH experience

BSN preferred

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote role with a consistent Monday–Friday 12:00 PM – 8:30 PM EST schedule. The candidate will review behavioral health authorization requests, ensure appropriate levels of care, and apply evidence-based guidelines to determine medical necessity.

Responsibilities include coordinating with facilities, documenting determinations, and supporting discharge planning.