Utilization Management Clinician, Behavioral Health – Precertification

Job not on LinkedIn

🔥 14 hours ago

⛷️ Utah – Remote

⛷️ Utah – Remote

💵 $54.1k - $116.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health Careers

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10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Review behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate levels of care • Focus on inpatient mental health, detoxification services, and substance use rehabilitation programs • 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 • 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 • Collaborate with providers, facilities, and interdisciplinary clinical teams

🎯 Requirements

• Active, unrestricted Master's-level Behavioral Health license in the state of residence, such as LMSW, LCSW, LISW, LPC, or equivalent independent clinical license • OR active, unrestricted Registered Nurse (RN) license with psychiatric/behavioral health experience • 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 12:00 PM – 8:30 PM EST • Strong clinical decision-making and medical necessity review skills • Master's Degree in Social Work, Counseling, Psychology, or another Behavioral Health discipline for Behavioral Health Clinicians • Associate Degree in Nursing (ADN) with Behavioral Health experience for Registered Nurses • 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

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Fully remote opportunity • Consistent weekday schedule

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