# Behavioral Health Precertification / Utilization Management Clinician **Company**: CVS Health **Location**: Work from home, UT **Work arrangement**: remote **Experience**: senior **Job type**: full-time **Salary**: $54,095.00 - $116,760.00 **Category**: Healthcare **Industry**: Healthcare **Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/UT---Work-from-home/Utilization-Management-Clinician-Behavioral-Health---Precertification_R1083957?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply **Canonical**: https://yubhub.co/jobs/job_f279fe25-3ee ## Description We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience. 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 **Pay Range** The typical pay range for this role is: $54,095.00 - $116,760.00 **Benefits** 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. ## Skills ### Required - Behavioral Health - Utilization Management - Medical Necessity Review - Clinical Documentation - Evidence-based guidelines ### Nice to have - Geriatric populations - Chronically mentally ill populations - Medicare Behavioral Health guidelines - Typing and keyboarding skills - Multiple system navigation --- Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/UT---Work-from-home/Utilization-Management-Clinician-Behavioral-Health---Precertification_R1083957?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)