Utilization Management Clinician Behavioral Health - Precertification

CVS Health; Milton (MA); Remote; USD 54.000 - 117.000; Vollzeit

Zusammenfassung

CVS Health is seeking a Behavioral Health Precertification/UM Clinician to review authorization requests and determine medical necessity, focusing on inpatient mental health and substance use rehabilitation programs. You will document determinations and coordinate with facilities to gather additional information, supporting discharge planning and care transitions.

The role is 100% remote with a consistent Monday–Friday schedule and a comprehensive benefits package designed to support colleagues

Qualifikationen

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

Aufgaben

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate levels of care
• Focus on inpatient mental health and substance use rehabilitation program reviews
• Apply evidence-based guidelines and clinical practice standards to authorization decisions
• Document determinations, rationale, and recommendations accurately
• Coordinate with facilities and providers to obtain additional 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 and reduce denials

Kenntnisse

Clinical decision-making

Documentation skills

Computer proficiency

Typing speed

Medicare Behavioral Health guidelines

Ausbildung

Master's Degree in Social Work, Counseling, Psychology, or another Behavioral Health discipline

ADN with Behavioral Health experience

BSN

Jobbeschreibung

Behavioral Health Precertification / Utilization Management Clinician

100% Remote | Monday–Friday | 12:00 PM – 8:30 PM EST

Are you a licensed Behavioral Health professional or Psychiatric RN with Utilization Management experience? Join our team and play a critical role in reviewing behavioral health authorization requests, supporting appropriate levels of care, and ensuring members receive timely, evidence-based treatment.

As a Behavioral Health Precertification/UM Clinician, you will review behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate levels of care, with a primary focus on:

• Inpatient Mental Health
• Substance Use Rehabilitation Programs
• Review behavioral health assessments, treatment plans, progress notes, and clinical documentation to evaluate medical necessity
• Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions
• Document determinations, rationale, and recommendations accurately and thoroughly
• 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, services, or care management support
• Identify opportunities to improve quality, reduce denials, and optimize benefit utilization
• Active, unrestricted Master's-level Behavioral Health license in the state of residence, such as:
• LPC
• 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
• ~ Strong clinical decision-making and medical necessity review skills

Working knowledge of Medicare Behavioral Health guidelines
Strong typing and keyboarding skills
Excellent documentation and computer skills

Behavioral Health Clinicians

• Master's Degree in Social Work, Counseling, Psychology, or another Behavioral Health discipline

Registered Nurses

• Associate Degree in Nursing (ADN) with Behavioral Health experience

Bachelor of Science in Nursing (BSN)

• Fully remote opportunity
• Consistent weekday schedule
• Specialized Behavioral Health Utilization Management role
• Opportunity to support vulnerable populations through evidence-based care decisions
• Collaborative environment with providers, facilities, and interdisciplinary clinical teams
• Meaningful work that directly impacts access to behavioral health treatment and recovery services

Full time Pay Range

The typical pay range for this role is:

$54,095.00 - $116,760.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 10/24/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.