Behavioral Health Utilization Management Reviewer

AmeriHealth Caritas

Your career starts now. We're looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we're passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at **Responsibilities:** Under the direction of the Supervisor, the BH UM Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and experience, the clinician reviews provider requests for inpatient and outpatient services, working closely with providers to collect all information necessary to perform a thorough medical necessity review. It is within the BH UM Reviewer's discretion to retain requests for additional information and/or request clarification. The BH UM Reviewer will use his/her professional judgment to evaluate the request to ensure that appropriate services are being requested and refer those cases to integrated care management as needed. The BH UM Reviewer will apply the appropriate medical necessity criteria to authorize services and appropriately identify and refer requests to the Medical Director when indicated. The BH UM Reviewers are responsible for ensuring that the treatment delivered is appropriately utilized and meets the member's needs in the least restrictive, least intrusive manner possible. The BH UM Reviewer will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit's business and uses clinical judgment in their application. **Education/Experience:** - Registered Nurse required OR Master's Degree in Social Work or Counseling with LICSW, LCSW, LCMHC or LCPC - 3 to 5 years prior experience in behavioral health/human services required; or other equivalent background and experience that would translate well to this position **Diversity, Equity, and Inclusion** At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve. We keep our associates happy so they can focus on keeping our members healthy. **Our Comprehensive Benefits Package** Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.
Vacancy posted a month ago
Similar jobs that could be interesting for youBased on the Behavioral Health Utilization Management Reviewer in United States vacancy
  •  ...it most. We offer integrated managed care products,...  ...specialty pharmacy services, behavioral health services, and other administrative...  ...of the Supervisor, the BH UM Reviewer is responsible for completing...  ...delivered is appropriately utilized and meets the member's needs... 
    Suggested
    Holiday work
    Christmas work
    Remote job
    Flexible hours
    Weekend work
    Monday to Friday

    AmeriHealth Caritas

    United States
    11 days ago
  •  ...most. We offer integrated managed care products, pharmaceutical...  ...pharmacy services, behavioral health services, and other administrative...  ...LTSS) Supervisor, the LTSS Reviewer is responsible for completing...  ..., nature of the request, utilization determination (and events leading... 
    Suggested
    Holiday work
    Remote job
    Flexible hours

    AmeriHealth Caritas

    United States
    a month ago
  •  ...physicians, nurse case managers, and other disciplines...  ...level of care utilizing evidence-based criteria...  ...and Case Management. Reviews the appropriateness of...  ...Collaborates with family, health care team, payors, and...  ...Caring process and the behavioral expectations in all... 
    Suggested
    Holiday work
    Full time
    Contract work
    Work experience placement
    Flexible hours

    DOCTORS HEALTHCARE PLANS, INC.

    Coral Gables, FL
    2 days ago
  •  ...Career worklet, please review this tip sheet ( . The...  ..., demonstrating behavior that reflects integrity...  ...particularly related to health information and coding applications utilized for daily job performance...  ...documentation issues, denial management issues and coding... 
    Suggested
    Full time
    Temporary work
    Remote job
    Worldwide

    Lensa

    Hialeah, FL
    12 days ago
  • **Department Name:** Utilization Mgmt **Work Shift:** Day **Job Category:** Clinical Care...  ...than ever for nurses at Banner Health, we make things better than ever for...  ...a **Registered Nurse RN Utilization Management Care Reviewer,** you will be working in partnership... 
    Suggested
    Remote job
    Shift work
    Monday to Friday

    Banner Health

    Arizona
    10 days ago
  •  ...to Work” company is seeking a Physician to provide utilization review services for the Group Health Department. This role requires utilizing clinical expertise...  ...background required Experience in Utilization Management with criteria review utilizing standard practice guidelines... 

    Dane Street

    New York, NY
    2 days ago
  •  ...Summary: Responsible for concurrent review (during the patient stay) of...  ...record during the hospitalization. Utilization of abstracting and data entry software...  ...information and reports findings to the Health Information Management, Quality Management, and Utilization... 
    Holiday work
    Full time
    Shift work
    Rotating shift

    University of New Mexico - Hospitals

    Albuquerque, NM
    3 hours ago
  •  ...Authority, to provide program delivery and program management services for one of the largest planned...  ...Manager – Reports of Investigation (“ROI”) and the Utilities Senior Project Manager, the Utility Design Reviewer contributes alongside a team of Utility Design Reviewers... 
    Remote job
    Relocation

    Fluor Corporation

    California
    3 days ago
  • ezURs is a URAC accredited Independent Review Organization. ezURs affords our clients true...  ...perform a wide variety of world-class utilization review, disability, peer reviews...  ...in multiple lines of business including health, workers compensation, and auto liability... 
    Hourly pay
    Contract work
    For contractors
    Immediate start
    Remote job
    Flexible hours

    ezURs

    Richardson, TX
    14 days ago
  • Genex Service LLC Utilization Reviewer US-PA-Remote Job ID: 25-17896 Type: Regular Full-Time #...  ...accidents. We support their journey back to health and wellness through our industry-...  ..., contributing to effective claims management and optimal patient outcomes. Uses solid... 
    Full time
    Local area
    Remote job
    Work from home

    Genex Services

    Wayne, PA
    2 days ago
  •  ...Travel/Less than 25% Job Shift Monday - Friday, 8am - 5pm Job Category Health Care Description StarCare Specialty Health System (StarCare) is seeking a full time Utilization Management Reviewer to join its outstanding Utilization Management team supporting the... 
    Hourly pay
    Holiday work
    Full time
    Local area
    Remote job
    Shift work
    Monday to Friday

    StarCare Specialty Health System

    Lubbock, TX
    4 days ago
  •  ...physicians; conducts admission and concurrent reviews; identifies patients who do not meet...  ...experience or three (3) years utilization/case management or 3rd party payer work experience....  ...Certification/Registration: Registered Nurse (RN) with current Florida License UF Health
    Full time
    Work experience placement

    UF Health

    Gainesville, FL
    1 day ago
  •  ...professional on our Medical Management/Health Services team. Centene is a...  ...and monitor care for behavioral health and substance abuse...  ...appropriateness of care Conduct peer reviews with psychologist and...  ...best practice models and utilization management processes Interact... 
    Holiday work
    Full time
    Remote job
    Flexible hours

    Sunshine State Health Plan

    Florida
    1 day ago
  •  ...demonstrate accountable behavior and share our values...  ...care. The Clinical Reviewer reviews and approves...  ...Responsible to process Home Health Starts of Care (SOC)...  ...Ensures that service utilization correlates with the...  ...Assists the clinical management staff with conducting... 
    Full time
    Local area
    Work from home
    Home office

    Ohio Living

    Worthington, OH
    1 day ago
  •  ...Hours per pay period: 1.0 Department: Health Information Management Shift: 8:30am - 5pm Monday through...  ...into the appropriate quality review queue or committed into the patient’s...  ...assist in the training of new hires by utilizing operational knowledge of prepping, scanning... 
    Daily paid
    Holiday work
    Temporary work
    Shift work
    Monday to Friday

    UnityPoint Health

    Madison, WI
    10 days ago
  •  ...rewards package that supports the health, life, career and retirement...  ...prescription drug and behavioral health coverage as well as free...  ...performing duties in support of the management of the Horizon Patient Folder...  ...parental responsibility. Reviews patient medical records and... 
    Full time
    Temporary work
    Part time
    Flexible hours

    St. David's Round Rock Medical Center

    Round Rock, TX
    1 day ago
  •  ...rewards package that supports the health, life, career and retirement...  ...prescription drug and behavioral health coverage as well as free...  ...performing duties in support of the management of the Horizon Patient Folder...  ...parental responsibility. Reviews patient medical records and... 
    Full time
    Temporary work
    Part time
    Flexible hours

    Mission Hospital

    Waynesville, NC
    4 days ago
  •  ...rewards package that supports the health, life, career and retirement...  ...prescription drug and behavioral health coverage as well as free...  ...performing duties in support of the management of the Horizon Patient Folder...  ...parental responsibility. Reviews patient medical records and... 
    Hourly pay
    Full time
    Temporary work
    Part time
    Flexible hours
    Shift work
    Monday to Friday

    HCA HealthONE Aurora

    Aurora, CO
    3 hours ago
  •  ...Street, a nationally recognized Independent Review Organization (IRO), is expanding its...  ...Compensation Board Certification to conduct Utilization Reviews. This is a fully remote, non-...  ...-friendly portal and streamlined case management Full onboarding and ongoing support included... 
    Price work
    For contractors
    Second job
    Remote job
    Flexible hours

    Dane Street

    New York, NY
    4 days ago
  • Position Physician Reviewer (Doctor of Medicine or Psy.D) Position Type : Contract Location...  ...and physician level guidance in quality management, utilization management, and care management. The Physician reviewer supports all Health Plan departments in meeting the... 
    Holiday work
    Contract work
    Part time
    Immediate start
    Remote job
    Saturday

    Alura Workforce Solutions

    Rancho Cucamonga, CA
    3 hours ago
  •  ...- $332260.00 The MSO Physician Reviewer is responsible for ensuring the appropriate utilization of healthcare services while maintaining...  ..., UM team members, and case managers to facilitate efficient and...  ...-based care models, population health management, and healthcare cost... 

    North East Medical Services

    Burlingame, CA
    1 day ago
  • ezURs is a URAC accredited Independent Review Organization. ezURs affords our clients true...  ...perform a wide variety of world-class utilization review, disability, peer reviews...  ...in multiple lines of business including health, workers compensation, and auto liability... 
    Hourly pay
    Contract work
    For contractors
    Immediate start
    Remote job
    Flexible hours

    ezURs

    Richardson, TX
    13 days ago
  •  ...Street, a nationally recognized Independent Review Organization (IRO), is expanding its...  ...Compensation Board Certification to conduct Utilization Reviews. This is a fully remote, non-...  ...-friendly portal and streamlined case management Full onboarding and ongoing support... 
    Price work
    Contract work
    For contractors
    Second job
    Remote job
    Flexible hours

    Dane Street, LLC

    New York, NY
    more than 2 months ago
  •  ...priority and delivery location are selected. Utilize image/scan on demand functionality as directed by team lead and/or manager. Promptly investigates record location...  ...the values to govern decisions, actions and behaviors. These values guide how we get our work... 
    Immediate start

    Cynet Systems

    Somerville, MA
    3 hours ago
  •  ..., scientists, digital innovators, program and construction managers and other professionals delivering projects that create a positive...  ...** **AECOM** is seeking an **Assistant Project Manager - Utility Design Reviewer** to be based in **Sacramento or Fresno, CA.** **JOB... 
    For contractors
    For subcontractor
    Remote job
    Worldwide
    Relocation
    Visa sponsorship

    AECOM

    Sacramento, CA
    more than 2 months ago
  •  ...pre-admission and admission review for Medicare and Medicaid beneficiaries...  ...staff, care team, and case managers as necessary to resolve...  ...regarding appropriate utilization of resources. •Promotes the...  ...Know Your Rights notice from the Department of Labor. OSS Health
    Full time
    Work experience placement
    Local area
    Immediate start
    Night shift

    OSS Health

    York, PA
    3 days ago
  • Summary VA Portland Health Care System is a Complexity Level 1a Facility...  ...record/health information management programs in accordance with...  ...statutes and regulations. Reviews and analyzes Joint Commission...  ...REAL ID compliant cannot be utilized as an acceptable form of identification... 
    Temporary work
    Work experience placement
    Seasonal work
    Remote job
    Relocation
    Monday to Friday

    Veterans Affairs, Veterans Health Administration

    Portland, OR
    1 day ago
  •  ...assignment serves as the Assistant Chief of Health Information Management who assists the Chief HIM in...  ...continuous announcement; applicants will be reviewed and sent to the manager on an as...  ...Rehabilitation Facilities (CARF), Behavioral Health, and the Office of Inspector... 
    Permanent employment
    Full time
    Temporary work
    Part time
    Work experience placement
    Immediate start
    Remote job
    Relocation

    Veterans Health Administration

    Los Angeles, CA
    4 days ago
  •  ...to ASA guidelines. 3. Information Management 3.1 The CRNA ensures appropriate...  ...high standard of moral and ethical behavior, professionalism, compassion, and commitment...  ...-CRNA must possess the emotional health required for full utilization of intellectual abilities, the... 
    Holiday work
    Full time
    Work experience placement
    Immediate start
    Relocation package
    Relocation bonus
    Flexible hours
    Shift work
    Night shift

    Yale New Haven Health

    Woodbridge, CT
    1 day ago
  •  ...Become a part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral health...  ...management decisions, + Work includes computer-based review of moderately complex to complex clinical... 
    Weekly pay
    Holiday work
    Full time
    Temporary work
    Apprenticeship
    Remote job
    Work from home
    Home office

    Humana

    Little Rock, AR
    a month ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Behavioral Health Utilization Management Reviewer. Be the first to apply!

subscribeToSimilarBanner
Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions