Remote Behavioral Health Utilization Specialist

CVS Health; Williamstown (NJ); Remote; USD 54,000 - 143,000; Full time

Benefits offered by this job

12.5% shift differential

Fully remote position

Comprehensive benefits package

Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician to join the remote Utilization Management team. You will review preauthorization requests, document decisions, and coordinate with providers to ensure timely, appropriate behavioral health services.

The role requires an active licensed behavioral health credential in your state, 3+ years post-licensure experience with mental health and substance use disorders, and experience with utilization management or prior

Qualifications

• Active, unrestricted independent behavioral health license in your state of residence
• 3+ years of post-licensure behavioral health experience
• 3+ years of experience with mental health and substance use disorders
• Utilization management or prior authorization experience
• Managed care experience
• Behavioral Health Clinicians: Master's degree in Social Work, Counseling, or Psychology
• Registered Nurses: Bachelor's degree in Nursing with emphasis in Behavioral Health or Psychology
• Fully remote position available anywhere in the U.S. with an additional 12.5% shift differential

Responsibilities

• Review preauthorization requests for behavioral health services using evidence-based guidelines and clinical judgment
• Coordinate, document, and communicate utilization management decisions with providers and stakeholders
• Ability to manage crisis calls, assess risk, determine support needs, and coordinate interventions including suicide risk and welfare checks
• Apply clinical expertise to support quality, cost-effective care and positive member outcomes
• Work in a fast-paced, queue-based environment while managing multiple priorities
• Collaborate with providers and care teams to facilitate appropriate levels of care

Skills

Behavioral health license

3+ years post-licensure

Telephonic work

Clinical judgment

Education

Master's degree in Social Work, Counseling, or Psychology

Bachelor's degree in Nursing (Behavioral Health/Psychology emphasis)

Job description

CVS Health is seeking a Behavioral Health Utilization Management Clinician to join the remote Utilization Management team. You will review preauthorization requests, document decisions, and coordinate with providers to ensure timely, appropriate behavioral health services.

The role requires an active licensed behavioral health credential in your state, 3+ years post-licensure experience with mental health and substance use disorders, and experience with utilization management or prior