Remote Behavioral Health Utilization Clinician

CVS Health; South Carolina; A distancia; USD 54.000 - 117.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Fully remote

Competitive benefits

Weekday schedule

Descripción de la vacante

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role with a Monday–Friday, 12:00 PM–8:30 PM EST schedule. You will review authorization requests, assess medical necessity, and determine appropriate levels of care for inpatient mental health, detox, and substance use programs.

The ideal candidate holds an active Behavioral Health license or an RN with psychiatric/behavioral health experience and has 1+ year of UM/UR experience, plus 3+ years inpatient

Formación

• 1+ year of Behavioral Health Utilization Review or Utilization Management experience
• 3+ years of inpatient behavioral health experience in a hospital setting
• Recent behavioral health experience or continuous behavioral health-focused work history
• Ability to work the scheduled hours of 12:00 PM – 8:30 PM EST
• Strong clinical decision-making and medical necessity review skills

Responsabilidades

• Review behavioral health authorization requests and clinical documentation to determine medical necessity
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions
• Coordinate with facilities and providers to obtain additional clinical information when needed
• Support discharge planning and transitions of care
• Communicate authorization decisions and next steps to providers

Conocimientos

Behavioral health utilization review

Inpatient behavioral health experience

Clinical decision making

Medical necessity review

Educación

Master's Degree in Behavioral Health

ADN with Behavioral Health experience

BSN preferred

Descripción del empleo

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a fully remote role with a Monday–Friday, 12:00 PM–8:30 PM EST schedule. You will review authorization requests, assess medical necessity, and determine appropriate levels of care for inpatient mental health, detox, and substance use programs.

The ideal candidate holds an active Behavioral Health license or an RN with psychiatric/behavioral health experience and has 1+ year of UM/UR experience, plus 3+ years inpatient