PMHNP - Behavioral Health Utilization Review Lead
Molina Healthcare
Molina Healthcare is seeking a PMHNP for behavioral health utilization reviews in Florida. This role requires applying evidence-based criteria, reviewing medical records, and collaborating with physicians to ensure clinically appropriate, cost-effective care. The candidate must hold an active Florida PMHNP license, have 3+ years in managed care or behavioral health, and be proficient with regulatory guidelines. Cross-state licensure is expected for national coverage. #J-18808-Ljbffr Molina Healthcare
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the PMHNP - Behavioral Health Utilization Review Lead in Brooklyn, NY vacancy
- Manager of Case Management at Surgery Partners, Inc. leads the case management team with a strong focus on utilization review, ensuring compliant care and reducing unnecessary hospital stays. This role collaborates across departments to optimize care coordination and outcomes...Suggested
- Job Summary Performs behavioral health utilization reviews, applying evidence-based criteria, and collaborating with physicians to ensure clinically appropriate... ...cost-effective member care. * Must have active Florida PMHNP license. Job Duties Performs Behavioral Health...SuggestedRemote jobHourly payWork experience placement
- Beyond Blue is seeking a Supervisor, Utilization Review to lead the daily operations of the utilization review team in the UK. The role ensures compliance with payer guidelines and regulatory standards while guiding staff performance and quality assurance. Responsibilities...Suggested
- Hilo Benioff Medical Center is seeking an experienced Registered Nurse IV to join our Utilization Review team. This role ensures medical necessity and appropriate level of care while supporting reimbursement through clinical reviews. The ideal candidate brings strong clinical...Suggested
- CommuniCare Family of Companies is seeking a Psychiatric Mental Health Nurse Practitioner (PMHNP) to join Brookside Healthcare Center in Cincinnati, Ohio.... ...and treat residents in a long-term care setting, leading personalized care plans in collaboration with a multidisciplinary...SuggestedFull time
- Nexus Health Systems is seeking a Clinical Reviewer to support the evaluation and admission of patients in our behavioral health, neurodevelopmental, and medically complex programs. The role requires RN or NP credentials with strong documentation and clinical judgment,...
$66.83k - $111.38k
...Wisconsin, Wyoming. Job Responsibilities Utilization Review Nurse is responsible for utilizing... ...preferred Knowledge of NCQA preferred Sentara Health Plans provides health plan coverage to... ...programs, and integrated clinical and behavioral health services—all to help our...Remote jobPermanent employmentFull timeTemporary workShift workDay shift$128.43k
One Health is seeking a full-time Psychiatric Nurse Practitioner... ...in healthcare. The PMHNP is responsible for... ...health center patients utilize other health care... ...participation in peer review, policy development and... ...provide integrated medical, behavioral health, community health...Full timeLocal area$140k - $191k
...minimum 1 year direct PMHNP experience... ...deliver high quality behavioral healthcare. Seeking... ...package W2: health, dental, vision, life... ...is to help people lead healthier, more fulfilling... ..., our recruiters utilize email addresses... ...they will not be reviewed or responded to....Full timeWork at officeRemote workRelocation packageFlexible hours$218k - $280k
At LifeStance Health, we believe in a truly... ...is to help people lead healthier, more fulfilling... ...the best team in behavioral health. We are... ...as a licensed PMHNP in an outpatient setting... ..., our recruiters utilize email addresses... ...they will not be reviewed or responded to....Full timePart timeRelocation packageFlexible hours$240k - $270k
At LifeStance Health, we believe in a truly... ...is to help people lead healthier, more fulfilling... ...the best team in behavioral health. Thank you... ...Practitioner (PMHNP) within Fort... ...Additionally, our recruiters utilize email addresses... ...they will not be reviewed or responded to....Local areaFlexible hours- LifeStance Health is seeking PMHNP-BCs in Illinois for in-person behavioral health care, serving adults and children/adolescents. Open to full-time or part-time schedules with a comprehensive benefits package. Position includes generous signing bonus, malpractice insurance...Full timePart timeRelocation package
$99.47k - $144.64k
Mass General Brigham Health Plan Holding Company, Inc... ...one of the world’s leading integrated healthcare... ...and OneCare products) utilization management staff. The... ...utilization management reviews utilizing InterQual®,... ..." by specifying which behaviors are most critical for...Work at officeRemote workMonday to FridayFlexible hoursShift workWeekend work- Personify Health is hiring an LVN-licensed reviewer to assess outpatient, inpatient, and mental health pre-certifications for medical appropriateness and necessity. You will also drive post-service reviews to verify medical necessity, escalate complex cases, and coordinate...
- ...Care Model, (2) Supporting the behavioral health outcomes of the team's population through case review, brief consultation with the... ...management of high risk, high utilizing members with co-occurring behavioral... ...Nurse Practitioner (PMHNP DEA BLS certification required...Full timePart timeLocal area
$100k - $115k
Director, Psychiatric Mental Health Nurse Practitioner (PMHNP) Program Job Category :... ...Whitaker Holmes School of Behavioral and Health Sciences, and Dean... ...and assessment needs, utilizing a variety of teaching techniques... ...information, please review the Know Your Rights notice...Full timeLocal area$55 - $65 per hour
...Registered Nurse With Utilization Review Experience A healthcare organization is seeking a Registered Nurse with utilization review experience to support non-acute clinical review activities. This contract opportunity is based in the Queens, NY area and requires an...Hourly payContract workATRIA Consulting
East Elmhurst, NY2 days ago- ...Job Title: RN - Utilization Review (000298) Keywords: Number of Positions: 1 Remaining Positions: 1 Duties: 1 year of non-acute utilization review experience - required RN experience - preferred This is the pay range that RightSourcing (a part of Magnit) reasonably expects...
Compu-Vision Consulting
Elmhurst, NY3 days ago $2,749.5 per month
...Nursing Profession RN Specialty Case Manager Job ID 35546746 Job Title RN - Utilization Review (000298) Weekly Pay $2749.5 Shift Details Shift Day - 8x5 - 09AM Scheduled Hours 40...Weekly payShift workRikers Island Correctional Facility
East Elmhurst, NY2 days ago$2,940.02 per month
...Details Client Name HHC Correctional Health Services Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 19018147 Job Title RN - Utilization Review (000298)...Weekly payShift workDay shiftTalent4Health
East Elmhurst, NY4 days ago- ...Job Description Job Summary: Seeking an experienced Registered Nurse specializing in utilization review to assess non-acute cases. This role involves evaluating patient records to ensure appropriate care and resource utilization while maintaining compliance with...
TactStaff
East Elmhurst, NY2 days ago $2,883.5 per month
...Details Client Name New York City Health and Hospitals Corporation-Rikers Island Job Type Travel Offering... ...Nursing Profession RN Specialty Utilization Review Job ID 19030015 Job Title RN - Utilization...Weekly payShift workTrinity Health
Elmhurst, NY3 days ago- ...Skills: ~1 year of non-acute utilization review experience - required ~ RN experience - preferred Certification: New York State RN License Primary Source Verification AHA BLS Shift: ~8:30 AM-5:00 PM ~42.50 houris/week...Shift work
ATD Technology LLC
East Elmhurst, NY3 days ago $110k
...Summary Comprehensively plans with the health care team to ensure patient needs are met... ...time frame and with the most efficient utilization of resources. Carries out activities related... ...documentation for justification. Reviews the patient’s plan of care in conjunction...Daily paidFull timePart timeFlexible hoursShift workMontefiore Nyack
Brooklyn, NY3 days ago- RN - Utilization Review Shift: 5 Day Shifts X 8 Hrs Start Date: 09/14/2026 End Date: 11/07/2026 Duration: 8 Week(s) City: East Elmhurst State: NY TALENTShift workDay shift
- RN - Utilization Review Shift: Days Shifts Per Week: 5 Scheduled Hours: 40 Start Date: 09/14/2026 End Date: 11/07/2026 Duration: 8 Week(s) City: Elmhurst State: NY VOCA HealthcareShift work
- ...We are seeking an experienced Registered Nurse (RN) - Utilization Review to evaluate the medical necessity, appropriateness, and level... ...guidelines, and collaborate with physicians, case managers, health plans, and other healthcare professionals to ensure appropriate...
Orison Solutions
East Elmhurst, NY3 days ago $2,868 per week
...Prime Staffing is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in New York City, New York. Job Description & Requirements ~ Specialty: Utilization Review ~ Discipline: RN ~ Start Date: 09/21/2026 ~ Duration: 8 weeks...Permanent employmentTemporary workZero hours contractShift workPrime Staffing
Grand Central, NY4 days ago- ...part of the East Hawaii Region of Hawaii Health Systems Corporation, is seeking a... ...Professional Nurse III to support our Utilization Review and Appeals functions. This role is responsible... ...Description As the Big Island’s leading providers of inpatient and outpatient care...Full timeShift workWeekend work
- L.A. Care Health Plan in Los Angeles, CA is seeking a Utilization Management (UM) Claims Review Nurse RN II to evaluate medical claims for medical necessity, documentation, and proper coding. This role supports payment integrity through pre-payment and retrospective reviews...
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to PMHNP - Behavioral Health Utilization Review Lead. Be the first to apply!
Related searches
- pmhnp Brooklyn, NY
- psychiatric np Brooklyn, NY
- psychiatric nurse practitioner pmhnp Brooklyn, NY
- mental health nurse practitioner Brooklyn, NY
- psychiatric mental health nurse practitioner pmhnp Brooklyn, NY
- psychiatric mental health nurse practitioner Brooklyn, NY
- natural health Brooklyn, NY
- health receptionist Brooklyn, NY
- rwjbarnabas health Brooklyn, NY
- nurse practitioner - women's health Brooklyn, NY