Remote Behavioral Health Utilization Clinician

CVS Health; Salem (NH); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Fully remote opportunity

Great benefits for colleagues

Bonus eligibility

Job summary

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a 100% remote role. The position focuses on reviewing authorization requests, ensuring appropriate levels of care, and supporting timely, evidence-based treatment.

Responsibilities include evaluating medical necessity, applying Medicare/behavioral health guidelines, coordinating with facilities, and aiding discharge planning. Requires licensed BH professional or psychiatric RN with UM experience.

Qualifications

• Active, unrestricted Master’s-level Behavioral Health license in state of residence (e.g., LMSW, LCSW, LISW, LPC, equivalent).
• OR active, unrestricted RN license with psychiatric/behavioral health experience.
• 1+ year in Behavioral Health Utilization Review/UM.
• 3+ years inpatient behavioral health in hospital setting.
• Scheduled hours 12:00 PM – 8:30 PM EST.
• Strong clinical decision-making and medical necessity review skills.

Responsibilities

• Review behavioral health assessments, treatment plans, progress notes to evaluate medical necessity.
• Apply evidence-based behavioral health guidelines and clinical standards to authorization decisions.
• Coordinate with facilities and providers to obtain additional information.
• Support discharge planning and transitions of care; communicate decisions to providers.

Skills

Utilization Management

Clinical decision-making

Behavioral Health

Inpatient experience

Education

Master's degree in Behavioral Health

ADN in Nursing

BSN preferred

Tools

Medicare guidelines

Job description

CVS Health is seeking a Behavioral Health Precertification/Utilization Management Clinician for a 100% remote role. The position focuses on reviewing authorization requests, ensuring appropriate levels of care, and supporting timely, evidence-based treatment.

Responsibilities include evaluating medical necessity, applying Medicare/behavioral health guidelines, coordinating with facilities, and aiding discharge planning. Requires licensed BH professional or psychiatric RN with UM experience.