Remote Behavioral Health Utilization Reviewer
Health Net Health Plan of Oregon, Inc.
- Remote job
Centene is seeking a Utilization Review Clinician to assess mental health and substance use care across the continuum. Two schedules are available, with 10-hour shifts, in Central or Eastern Time Zones. Start times: 8:00 or 9:00 AM ET. Requires RN or Master’s in Behavioral Health, 2–4 years of related experience, and licensure. You will educate providers and families, review plans, and collaborate with medical directors to improve care quality. #J-18808-Ljbffr Health Net Health Plan of Oregon, Inc.
- ...Comagine Health is seeking a Clinical Reviewer to work remotely from Oregon with travel across the Eugene and surrounding areas. You will... ...requires licensure, 3 years of direct patient care in behavioral health, and familiarity with utilization review. #J-18808-Ljbffr...Remote work
- ...Umpqua Health is seeking an Utilization Review Clinician to perform clinical reviews for mental health and substance use services. This remote role may require on-site travel to Roseburg, OR as needed and offers a full-time exempt schedule. The URC collaborates with care...Remote workFull time
- Comagine Health is seeking a Behavioral Health Reviewer based in Oregon. Responsibilities include reviewing clinical documentation for medical necessity, conducting assessments, and managing referrals in a remote capacity. Applicants should possess a relevant master's degree...Remote job
$80.75k - $98.68k
...colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care... ...level of care to promote optimal health. This position is self-directed and... ...professionals, including medical and behavioral health care managers, dieticians, pharmacist...SuggestedFull timeShift work- ...coordinating, integrating, and monitoring the utilization of behavioral health (BH) or physical health (PH) services... ...cases to the Medical Director for review. Refer to and work closely with Case... .... Please note: The opportunity for remote work may be possible for all jobs...Remote workContract workWork at office
- ...organization is seeking experienced Physician Reviewers to join their Medicare Utilization Management team in a remote position. Responsibilities include reviewing clinical... .... A comprehensive benefits package including health plans and 401(k) is offered, promoting equality...Remote work
- A leading independent review organization is seeking a Utilization Management Physician Reviewer for a full-time remote role. Candidates must possess an active Nebraska medical license and have a minimum of 5 years clinical practice experience. Responsibilities include...Remote workFull timeCasual workMonday to Friday
- Nationwide Children’s Hospital is seeking a Behavioral Health Utilization Review Specialist to review cases, determine medical necessity, and ensure compliance with guidelines. The role conducts pre-certifications, pre-authorizations, and retrospective reviews, collaborating...Remote jobWork at officeWork from home
$219k - $286.9k
...Physician Reviewer - Utilization Management Hi, we're Oscar. We're hiring a Physician Reviewer... ...Management team. Oscar is the first health insurance company built around a full... ...Management. Work Location: This is a remote position, open to candidates who reside...Remote workFull timeLocal areaWork from homeHome officeWeekend work- Nationwide Children's Hospital is seeking a utilization review professional to evaluate behavioral health cases, ensuring medical necessity and guideline alignment... ...a 90-day in-office training, the position offers remote work from home options. #J-18808-Ljbffr Nationwide...Remote jobWork at officeWork from home
- A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board certification and unrestricted medical license in relevant states. The role involves performing detailed...Remote jobFull timeWork from home
- ...Dane Street, a certified "Great Place to Work" company is seeking a Physician to provide utilization review services for the Group Health Department. This role requires utilizing clinical expertise to review medical records and provide an interpretation of the medical...Remote work
$219k - $286.9k
Oscar Health is hiring a Physician Reviewer to join our Utilization Management team. You will determine the medical appropriateness of inpatient, outpatient, and... ...information and applying evidence-based guidelines. This remote role in the United States offers work from home...Remote jobWork from home$174.07k - $374.92k
...Full-Time Utilization Management Physician Reviewer We're building a world of health around every individual — shaping a more connected, convenient and compassionate... ...time. Company: Oak Street Health Location: Remote/ Treehouse Role Description: This full-...Remote workHourly payFull time- ...physician with strong clinical and UM background to cover delegated utilization management across multiple territories. The role requires... ..., and 2+ years in hospital medicine, with utilization review experience preferred. You will coordinate with PCP/SNF meetings...Remote job
$130 - $145 per hour
Hi, we're Oscar. We're hiring a Behavioral Health Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around... ...Management. Work Location: This position is fully remote and open to candidates residing in the U.S.,...Remote workHourly payPart timeWork from homeHome office- Oak Street Health is seeking a Full-Time Utilization Management Physician Reviewer to provide accurate coverage determinations for inpatient and outpatient services, applying UM criteria, clinical judgment, and internal policies. You will coordinate with care teams to ensure...Remote jobFull time
- ChenMed LLC is seeking a Physician Reviewer to lead delegated utilization management (UM) reviews across multiple markets. You will establish daily case counts, attend essential calls with health plans, advise other reviewers, and participate in ongoing process and quality...Remote job
- A recognized healthcare provider is seeking a Board Certified Orthopaedic Spine Surgeon to conduct utilization reviews. This telework position allows for a flexible schedule within a standard Monday - Friday work week. Responsibilities include reviewing medical records,...Remote jobFor contractorsMonday to FridayFlexible hours
- Overview Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of... ...Workers’ Compensation Board Certification to conduct Utilization Reviews. This is a fully remote, non-clinical role offering supplemental income with flexible...Remote workPrice workExtra incomeFor contractorsFlexible hours
$27.02 - $48.55 per hour
...Mental Health And Substance Abuse Clinical Reviewer Position Purpose: Performs a clinical... ...the flexibility to work remotely from their home anywhere... ...Performs concurrent review of behavioral health (BH) inpatient to... ...quality and appropriate utilization of services Provides...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hours- ...Sentara Health in Richmond, VA is hiring a Behavior Health Utilization Management Care Coordinator to support members who are medically and behaviorally complex. The role requires both in-person assessments and remote telephonic assessments for serious mental illness,...Remote work
$65k - $88.6k
...Become a part of our caring community The Utilization Management Behavioral Health Professional uses behavioral health knowledge and skills to support... .../ HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday- FHE Health is seeking a Utilization Review Specialist to manage clinical authorization processes and coordinate with insurance payers for timely authorizations... ...candidate should have 2-3 years of UR experience in behavioral health, with strong ASAM criteria knowledge and...Remote job
- Point32Health in Massachusetts seeks a Behavioral Health Utilization Management Clinician to conduct benefit coverage reviews and clinical determinations under supervision within... ...while maintaining regulatory compliance. Remote work as required with a fast-paced environment...Remote job
- Sentara Health Plan PG in the United States seeks a Behavior Health Utilization Management Care Coordinator to work with medically and behaviorally complex members. The... ...both in-person face-to-face assessments and remote telephonic assessments for SMI, SED (ages 2+),...Remote work
- ATHENA Consulting is seeking a part-time Utilization Manager Clinician for a remote role based in Hanover, MD. The position reviews behavioral health services and coordinates case management to optimize member outcomes, requiring MD licensure and a health professional...Remote jobPart timeFlexible hoursWeekday work
$60.52k - $129.62k
...Care Plan Reviewer (Clinical Case Manager BH) We're building a world of health around every individual — shaping a more connected... ...(Clinical Case Manager BH) utilizes advanced clinical judgment and... ...supports appropriate member behavioral healthcare through review of...Remote workHourly payFull timeTemporary workLocal area$50k
...Employer Industry: Behavioral Healthcare Management Why consider this job opportunity... ...pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the... ...Qualifications) Bachelor’s degree in a health or behavioral health-related field required...Remote work- ...Role Overview Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient... ...independently applies medical and behavioral health guidelines to authorize services,... ...Flexible work solutions include remote options, hybrid work schedules, competitive...Remote workMonday to FridayFlexible hoursWeekend work
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