Remote Behavioral Health Utilization Clinician

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

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote, Monday–Friday role with a 12:00 PM – 8:30 PM EST schedule. The clinician reviews behavioral health authorization requests, determines medical necessity, and ensures appropriate levels of care to support timely treatment.

The ideal candidate holds a Master’s in Behavioral Health and has 1+ year of utilization management experience plus about 3+ years in inpatient behavioral health.

Qualifications

• Licensed Behavioral Health professional in state of residence.
• 1+ year of Behavioral Health Utilization Review/Utilization Management experience.
• Approximately 3+ years inpatient behavioral health experience in a hospital setting.
• Recent behavioral health experience or continuous behavioral health-focused work history.
• Strong clinical decision-making and medical necessity review skills.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity.
• Evaluate levels of care and ensure timely access to treatment.
• Apply evidence-based behavioral health guidelines and standards to authorization decisions.
• Document determinations, rationale, and recommendations.
• Coordinate with facilities/providers to obtain additional clinical information when needed.
• Support discharge planning and transitions of care.
• Identify members who may benefit from additional clinical programs or care management support.
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization.

Skills

Utilization Review

Behavioral Health

Inpatient Psychiatry

Clinical Decision-Making

Medical Necessity Review

Education

Master's in Behavioral Health

ADN with Behavioral Health experience

BSN

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician for a 100% remote, Monday–Friday role with a 12:00 PM – 8:30 PM EST schedule. The clinician reviews behavioral health authorization requests, determines medical necessity, and ensures appropriate levels of care to support timely treatment.

The ideal candidate holds a Master’s in Behavioral Health and has 1+ year of utilization management experience plus about 3+ years in inpatient behavioral health.