Remote Behavioral Health Utilization Clinician

CVS Health; Orangeburg (SC); Remote; USD 54,000 - 143,000; Full time

Benefits offered by this job

Shift differential 12.5%

Remote work 100%

Comprehensive benefits

Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a 100% remote role. The position involves reviewing preauthorization requests, coordinating utilization decisions, and handling crisis risk assessments while supporting quality and cost-effective care across diverse populations.

The role requires an active BH license, 3+ years post-licensure experience, and the ability to work telephonically and via computer in a fast-paced environment.

Qualifications

• Active, unrestricted independent behavioral health clinical license in your state.
• 3+ years of post-licensure behavioral health experience.
• 3+ years of experience with mental health and substance use disorders.
• Ability to manage telephonic and computer-based work simultaneously.
• Hospital-based behavioral health experience.
• Utilization Management or Prior Authorization experience.
• Managed Care experience.

Responsibilities

• Review preauthorization requests for behavioral health services using evidence-based guidelines and clinical judgment.
• Coordinate, document, and communicate utilization management decisions with providers and stakeholders.
• Ability to manage crisis calls, assess risk, and determine appropriate interventions including escalation for suicide risk.
• Apply clinical expertise to support quality, cost-effective care and positive member outcomes.
• Work in a fast-paced, queue-based environment while managing multiple priorities.
• Collaborate with providers and care teams to facilitate appropriate levels of care.

Skills

Post-licensure BH experience

Crisis risk assessment

Telephonic & computer-based work

Fast-paced environment

Education

Master's in Social Work, Counseling, or Psychology

RN with Behavioral Health emphasis

Job description

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a 100% remote role. The position involves reviewing preauthorization requests, coordinating utilization decisions, and handling crisis risk assessments while supporting quality and cost-effective care across diverse populations.

The role requires an active BH license, 3+ years post-licensure experience, and the ability to work telephonically and via computer in a fast-paced environment.