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Behavioral Health Precertification / Utilization Management Clinician at CVS Health - ApplyBlast

Behavioral Health Precertification / Utilization Management Clinician

CVS Health

28 days ago

3.2 on Glassdoor

Remote

Full Time

Medior

0 applicants

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About this role

This fully remote role involves reviewing behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate levels of care for inpatient mental health, detoxification, and substance use rehabilitation programs. The clinician collaborates with providers and facilities to support discharge planning, transitions of care, and crisis queue coverage while ensuring members receive timely, evidence-based treatment. The position requires a licensed Behavioral Health professional or Psychiatric RN with prior utilization management experience.

Responsibilities

Review behavioral health authorization requests and clinical documentation to determine medical necessity
Apply evidence-based behavioral health guidelines and clinical practice standards to authorization decisions
Coordinate with facilities and providers to obtain additional clinical information and support discharge planning

Skills

Qualifications

Master's Degree in Social WorkMaster's Degree in CounselingMaster's Degree in PsychologyRegistered Nurse (RN) licenseAssociate Degree in Nursing (ADN)

About CVS Health

cvshealth.com

Headquarters

Woonsocket, Rhode Island, United States

Company Size

10001+ employees

Founded

1963

View Profile

CVS Health is America's leading health solutions company, providing integrated services across retail pharmacy (CVS Pharmacy), pharmacy benefits management (CVS Caremark), and health insurance (Aetna). The company offers pharmacy services, health plans, clinical care (including MinuteClinic), and health-and-wellness programs for consumers, employers, and government payers. By combining a large national retail footprint with claims processing, care management, and clinical services, CVS Health aims to coordinate care, lower costs, and improve health outcomes. Businesses and consumers use its solutions for medication management, plan administration, and in-person and virtual care.