Remote Behavioral Health Utilization Clinician

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

Benefits offered by this job

Fully remote

Weekday schedule

Competitive benefits

Collaborative clinical teams

Job summary

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician to review authorization requests and clinical documentation for medical necessity and appropriate levels of care. The role centers on inpatient mental health, detox, and substance use rehabilitation programs, with a strong focus on evidence-based guidelines.

You will work 100% remotely with a consistent Monday–Friday schedule (12:00 PM – 8:30 PM EST).

Qualifications

• Active, unrestricted Master’s-level Behavioral Health license in the state of residence (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 appropriate levels of care
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions
• Utilize Medicare coverage criteria and requirements when applicable
• Document determinations, rationale, and recommendations clearly
• Coordinate with facilities and providers to obtain additional clinical information as needed
• Support discharge planning and transitions of care
• Communicate authorization decisions and next steps to providers and internal stakeholders
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization

Skills

Behavioral Health license

RN license (psychiatric)

Utilization Management experience

Inpatient behavioral health

Education

Master's degree in Behavioral Health

Associate Degree in Nursing (ADN)

BSN preferred

Job description

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician to review authorization requests and clinical documentation for medical necessity and appropriate levels of care. The role centers on inpatient mental health, detox, and substance use rehabilitation programs, with a strong focus on evidence-based guidelines.

You will work 100% remotely with a consistent Monday–Friday schedule (12:00 PM – 8:30 PM EST).