Remote Behavioral Health Utilization Clinician

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

Job summary

CVS Health in the United States is seeking a Behavioral Health Precertification/UM Clinician to review behavioral health authorization requests, determine medical necessity, and ensure appropriate levels of care for members.

This fully remote role offers a consistent weekday schedule (12:00 PM–8:30 PM EST), opportunities to collaborate with facilities and providers, and a chance to impact access to behavioral health services.

Qualifications

• Active, unrestricted behavioral health license in the state of residence (MLS, LCSW, LISW, LPC or equivalent).
• Registered Nurse with psychiatric/behavioral health experience and an active license.

Responsibilities

• Review behavioral health authorization requests to evaluate medical necessity and levels of care.
• Apply evidence-based guidelines and Medicare criteria where applicable.
• Document determinations, rationale and recommendations clearly.
• Coordinate with facilities to obtain additional clinical information as needed.

Education

Master’s-level Behavioral Health license

RN license with psychiatric/behavioral health experience

Job description

CVS Health in the United States is seeking a Behavioral Health Precertification/UM Clinician to review behavioral health authorization requests, determine medical necessity, and ensure appropriate levels of care for members.

This fully remote role offers a consistent weekday schedule (12:00 PM–8:30 PM EST), opportunities to collaborate with facilities and providers, and a chance to impact access to behavioral health services.