Remote Behavioral Health Utilization Clinician

CVS Health; Wilmington (VT); Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests and determine appropriate levels of care. This fully remote, weekday role focuses on inpatient mental health and substance use programs, with emphasis on evidence-based guidelines and thorough documentation.

You will collaborate with facilities, support discharge planning, and help optimize care utilization while maintaining a strong clinical decision-making approach.

Qualifications

• Active, unrestricted Master's-level Behavioral Health license in the state of residence (e.g., LPC).
• 1+ year of Behavioral Health Utilization Review/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.
• Strong clinical decision-making and medical necessity review skills.
• Working knowledge of Medicare Behavioral Health guidelines.
• Excellent documentation and computer skills.

Responsibilities

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate levels of care.
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions.
• Document determinations, rationale, and recommendations accurately.
• Coordinate with facilities and 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.
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization.

Skills

Behavioral Health UM review

Clinical decision-making

Medical necessity review

Documentation and computer skills

Education

Master's degree in Social Work, Counseling, Psychology

Associate Degree in Nursing (ADN)

Bachelor of Science in Nursing (BSN)

Job description

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests and determine appropriate levels of care. This fully remote, weekday role focuses on inpatient mental health and substance use programs, with emphasis on evidence-based guidelines and thorough documentation.

You will collaborate with facilities, support discharge planning, and help optimize care utilization while maintaining a strong clinical decision-making approach.