About this opportunity
CVS Health lists this Utilization Management Clinician Behavioral Health - Precertification opportunity in virginia beach, Virginia. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Were building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, youll 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.
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 Masters-level Behavioral Health license in the state of residence, such as:
LPC
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
~ 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
~ Masters 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
If youre an experienced Behavioral Health clinician or Psychiatric RN with Utilization Management expertise and a passion for ensuring members receive the right care at the right time, wed love to hear from you. 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.
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.