Clinician

• 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

Explore Utilization Management Clinician, Behavioral Health –… at CVS Health Careers. Review requirements and application details.

Clinician jobs in Utah

Utilization Management Clinician, Behavioral Health – Precertification