UT - Work from home · Remote
Full-time
Mid level
1 day ago
Verified apply link — checked 1 hour ago
Salary undisclosed
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. 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. What You'll Do 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 Detoxification Services Substance Use Rehabilitation Programs Key responsibilities include: 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 Utilize Medicare coverage criteria and requirements when applicable 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 Communicate authorization decisions and next steps to providers and internal stakeholders Identify members who may benefit from additional clinical programs, services, or care management support Participate in crisis queue coverage, including member triage, call handling, escalation, and documentation Identify opportunities to improve quality, reduce denials, and optimize benefit utilization WHAT YOU BRING - REQUIRED Active, unrestricted Master's-level Behavioral Health license in the state of residence, such as: LMSW LCSW LISW LPC Equivalent independent clinical license OR Active, unrestricted Registered Nurse (RN) license with psychiatric/behavioral health experience Additionally, candidates must have: 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 Ability to work the scheduled hours of 12:00 PM – 8:30 PM EST Strong clinical decision-making and medical necessity review skills Preferred Qualifications Experience working with geriatric populations Experience supporting chronically mentally ill populations Working knowledge of Medicare Behavioral Health guidelines Strong typing and keyboarding skills Ability to navigate multiple systems simultaneously Excellent documentation and computer skills Education 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 Preferred Bachelor of Science in Nursing (BSN) Why Join Us? 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 If you're an experienced Behavioral Health clinician or Psychiatric RN with Utilization Management expertise and a passion for ensuring me
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