Remote Behavioral Health Utilization Review Clinician
Centene
- Remote job
Centene is seeking a remote Health Care Reviewer focused on mental health and substance use to assess care and ensure medical appropriateness of services. The role supports the California market with flexible scheduling and requires nursing or related credentials plus BH utilization review experience. Responsibilities include prior authorization, concurrent BH reviews, data analysis to improve utilization, and education for providers, members, and families. Licensure in BH fields is preferred. #J-18808-Ljbffr Centene
- ...Centene is seeking a remote Utilization Review Clinician – Behavioral Health to support inpatient and outpatient BH Medicare plans. You will perform medical necessity reviews and authorization determinations to ensure members receive appropriate, high-quality BH services...Remote work
- ...Centene Management Company LLC in Texas seeks a experienced Behavioral Health Utilization Reviewer to evaluate and authorize mental health and substance abuse care. The role requires compliance with regulatory guidance and collaboration with BH teams to ensure appropriate...Remote work
- ...Centene Corp. is seeking a Utilization Review Clinician - Behavioral Health for a remote role in Georgia. Candidates must hold an active Georgia licensed clinician or compact nursing license and have BH experience. The role runs Monday–Friday 8:00 AM to 5:00 PM with...Remote workMonday to Friday
$27.02 - $48.55 per hour
...Performs a clinical review and assesses care... ...to mental health and substance abuse... ...concurrent review of behavioral health (BH)... ...and appropriate utilization of services Provides... ...health clinicians required. Clinical... ...approach to work with remote, hybrid, field or...Remote workHourly payFull timePart timeWork at officeFlexible hours- ...Management Company LLC in Louisiana seeks a qualified clinician to perform clinical reviews and assess care related to mental health and substance abuse. You will monitor level... ...an active Louisiana license, a nursing or behavioral health degree, and 2-4 years of related...Remote job
- Centene seeks a licensed professional to perform clinical reviews of mental health and substance use services to ensure appropriate level of... ...concurrent BH inpatient reviews, data analysis to improve utilization, and education for providers, members, and families. Licensure...Remote jobFlexible hours
- Centene Corporation seeks a remote Behavioral Health reviewer to support the Texas Ambetter Inpatient Behavioral Health population. The role requires 4 x 10-hour shifts weekly with Saturday availability; weekend differential is offered. You will evaluate care, perform prior...Remote jobShift workWeekend work
- ...Experience in both medical and behavioral health and/or substance use disorder... ...Paid Holidays Work-life balance Remote setting ROLE DESCRIPTION This individual will utilize clinical knowledge and... ...defer decision to a second level reviewer. This individual interfaces with...Remote workTemporary workWork at officeMonday to FridayFlexible hours
$75k - $90k
...process. Clinical Reviewer - LCSW, LPC, LCPC - Salem... ...This is a remote position based in Salem... ...improving access to behavioral health services in the community... ...evidence-based criteria to utilization management reviews;... ...Refer cases to other clinicians when appropriate...Remote workFull timeContract workWork from home- Centene Corp. is seeking a licensed clinician to perform clinical reviews and assess mental health and substance use care for medical appropriateness. The role supports the California market and is fully remote, with schedule options for CA residents and eligibility for...Remote jobShift work
- ...Recovery Unplugged is seeking an experienced Utilization Review Specialist to join our team. This remote, part-time role focuses on obtaining and maintaining... ...ideal candidate has prior utilization review or behavioral health experience, strong knowledge of payer...Remote workPart timeWeekend work
$60.52k - $129.62k
...We’re building a world of health around every individual —... .... This is a full-time remote Utilization Management Clinician opportunity that functions... ...practice guidelines for behavioral health and/or medical conditions... ...clinical expertise to review and evaluate treatment...Remote workHourly payFull timeTemporary workLocal areaMonday to Friday- ...The Arizona Health Care Cost Containment System (AHCCCS) is seeking a Behavioral Health Prior Authorization Utilization Review Consultant. The role focuses on monitoring, evaluating, and approving or denying payment for medical and behavioral health services for the Fee...Remote work
- ...FHE Health in the United States seeks an experienced Utilization Review Specialist to manage clinical authorization processes, ensuring timely, accurate, and compliant... ..., compliance, and high-quality patient care across behavioral health services. #J-18808-LjbffrRemote work
- ...a compact license. The Care Review Clinician will provide prior authorization for behavioral health services for the OH Medicaid... ...or previous experience with Utilization Reviews. WORK SCHEDULE: Monday... ...alternative work schedule. This is a remote position. Home office with...Remote workWork at officeHome officeMonday to Friday
$23.76 - $51.49 per hour
...a compact license. The Care Review Clinician will provide prior authorization for behavioral health services for the OH Medicaid... ...or previous experience with Utilization Reviews. WORK SCHEDULE Monday... ...alternative work schedule. This is a remote position. Home office with...Remote workHourly payWork experience placementWork at officeHome officeMonday to Friday- ...Toney Healthcare is seeking a physician reviewer for a remote contract role in Utilization Management. This position focuses on evaluating medical necessity... ...an MD or DO license, with at least 5 years of behavioral health clinical experience and a minimum #J-18808-Ljbffr...Remote workContract work
- ...The Utilization Review Clinical Specialist (URCS) at Behavioral Health Services North Inc conducts clinical utilization review across programs, focusing on the CCBHC model. They evaluate medical necessity, level of care, service intensity, frequency, and duration to ensure...
- ...Hines & Associates, Inc. is seeking a Nursing Review professional to validate outpatient and inpatient services against established criteria... .... This is a Monday–Friday position with standard daytime hours and remote setting options stated in the benefits. #J-18808-Ljbffr...Remote workMonday to Friday
$71.03k
AHCCCS Arizona Health Care Cost Containment System Accountability, Community... ...work environments, including remote work opportunities. With career paths... ...our dynamic and dedicated team. Behavioral Health Prior Authorization Utilization Review Consultant Division of Fee for...Remote workFull timePart timeInternshipWork from homeFlexible hours$24 - $26 per hour
...Utilization Review Specialist – Behavioral Health (Remote) PHP/IOP | Full-Time | Monday–Friday, 9 AM–5 PM ET | $24–$26/hour About the Role Principles Recovery Center (PRC) are hiring a Utilization Review (UR) Specialist to manage insurance authorizations for adolescent...Remote workFull timeMonday to Friday- ...NOXNOX is seeking an Assessment & Utilization Review (UR) Clinician in Ohio to conduct comprehensive behavioral health and substance use disorder intake assessments. The role coordinates insurance authorizations to ensure appropriate level of care and medical necessity...
$78.4k - $107.8k
...part of our caring community The Utilization Management Behavioral Health Nurse utilizes behavioral health... ...troubleshoot and resolve within a remote environment. ~ Ability to work independently... ..., performing medical necessity reviews against criteria such as MCG, ASAM,...Remote workFull timeTemporary workApprenticeshipWork from homeHome officeMonday to Friday- ...guidance and solutions to enhance health plans' clinical operations.... .... Role Description This is a remote contract role for a Utilization Management Physician Reviewer. Responsibilities include conducting... ...of clinical experience in behavioral health settings. At least 2...Remote workContract work
- ...One of the largest health benefits companies in the... ...benefits, dental, vision, behavioral health benefit... ...authorization and concurrent review. Provides monthly... ...treatment setting by utilizing the applicable medical... ...Additional Info: *possible remote opportunity after...Remote workContract workMonday to FridayFlexible hours
$90.9k - $129.9k
...Apply your expertise to adjudicate Behavioral Health prior authorizations based on medical... ...for this role, rather you will provide utilization review and quality assurance. Your role in... ...should expect in this role ~100% Remote home office. ~ Full-time position....Remote workFull timeWork experience placementHome officeFlexible hours- TriWest Healthcare Alliance is seeking a Utilization Management Clinical Review nurse to assess medical necessity and manage prior authorizations for Behavioral Health and Medical/Surgical requests. You will apply InterQual criteria, document in the management system,...Remote job
$54.1k - $116.76k
...We’re building a world of health around every individual — shaping a more... ...Position Summary This is a full-time, remote position with a working schedule... ...Arizona time zones. As a UM Clinician Behavioral Health you will: - Utilize clinical experience and skills in...Remote workHourly payFull timeTemporary workLocal areaMonday to FridayWeekend work- 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 work
- ...Hansei Solutions is seeking an Utilization Review Specialist to act as the vital link between insurance payors and treatment facilities, advocating for clients to secure maximum authorized treatment days. The role emphasizes communication, organization, data entry, multitasking...Remote work
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