Behavioral Health Utilization Review Clinician
$26.41 - $51.49 per hourMolina Healthcare of Illinois
Molina Healthcare is seeking a skilled behavioral health professional to provide support in clinical service reviews. The role involves assessing compliance and efficacy of member services, ensuring high-quality care. Applicants must hold appropriate behavioral health licensure and have solid experience in healthcare settings. The position is based in the Town of Florida, New York, with a competitive pay range of $26.41 - $51.49 per hour. #J-18808-Ljbffr Molina Healthcare
$26.41 - $51.49 per hour
...professionals to provide support for member clinical service review processes in California. The role involves ensuring... .... Candidates should have at least two years of health care experience, relevant behavioral health licensure, and excellent communication skills....SuggestedHourly pay$26.41 - $51.49 per hour
...Provides support for member clinical review processes specific to applied behavioral analysis (ABA) services.... ...Responsible for verifying that behavioral health services are medically necessary... ...Works collaboratively with the utilization and care management departments...SuggestedHourly payWork experience placementLive inWork at officeLocal area$26.41 - $51.49 per hour
...Summary Provides support for member clinical service review processes specific to behavioral health. Responsible for verifying that services are... ...multidisciplinary teams to promote Molina care model. Adheres to utilization management (UM) policies and procedures. May work...SuggestedHourly payWork experience placementWork at office$73.86k - $96.02k
...with clear pathways and ongoing support Comprehensive health and wellness resources that go beyond traditional... ...to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization. Coordinates with the healthcare team for optimal and...SuggestedLocal area- A technology-driven health insurance company in New York seeks a Recruitment Leader to evaluate clinical appropriateness of services... ...with at least 6 years of clinical experience and 1 year in utilization review. Responsibilities include timely medical reviews, clinical...SuggestedFull time
$73.86k - $96.02k
Baptist Health South Florida is seeking a qualified individual to conduct chart reviews for clinical financial resource utilization. The role requires effective communication with healthcare teams and various agencies to optimize patient outcomes. Qualifications include...- Medix™ is looking for an experienced Physician Reviewer to join their Utilization Management team. This remote position involves conducting utilization reviews across various services and ensuring compliance with healthcare regulations. Ideal candidates should be Board...Remote job
- Itlearn360 is seeking a dedicated Utilization Management professional based in the Town of Florida, New York. The role requires state licensure... ...in Utilization Management. Responsibilities include reviewing patient clinical information, coordinating with healthcare teams...Full time
$26.41 - $51.49 per hour
...Molina Healthcare in California, MO is seeking a Clinical Member Services Reviewer. The role includes assessing clinical service requests, ensuring compliance with regulations, and collaborating with teams for healthcare delivery. The ideal candidate has an active RN...Hourly pay- A healthcare services company is seeking a Clinical Care Reviewer based in Doral, FL. The role requires a current FL RN licensure and... ...settings such as ER or ICU. Candidates should have experience with Utilization Review, familiarity with Interqual Criterion, and good...
- TurningPoint Healthcare Solutions is hiring a Supervisor, Clinical Review Nurse in New York. This full-time role involves overseeing Utilization Management activities and leading a clinical team. Candidates should possess an active RN license, a minimum of five years of...Full time
$24 - $46.81 per hour
Molina Healthcare is seeking a healthcare professional for a support role in clinical member services. The position involves verifying service necessity according to established guidelines, ensuring cost-effectiveness and compliance with regulations to achieve desired outcomes...Hourly pay$26.41 - $51.49 per hour
Molina Healthcare is seeking a Behavioral Analyst to support member clinical review processes for ABA services. The role involves assessing compliance, analyzing clinical requests, and collaborating with care management departments to provide quality care to members with...Hourly pay- # Behavioral Health RN1635 East Hwy 50, Ste 101, Clermont, FL 34711February 24, 2026### Job Description... ...-day SNVs and OASIS within 48 hours* Utilize appropriate behavioral health and... ..., including responding to QA and coder reviews and performing clinical record audits*...
$62.7k - $100.4k
A healthcare organization is seeking a Clinical Care Reviewer II responsible for processing medical necessity reviews and assisting with care coordination activities. Candidates need to hold an Associate's degree in nursing and have at least three years of clinical experience...- A leading healthcare staffing firm is seeking a Registered Nurse for Concurrent Review in Florida. The role involves telephonic review of inpatient admissions to ensure appropriate medical necessity and care levels. Candidates must have an active RN license in Florida...Full timeWork at officeMonday to Friday
- Nurse Practitioner (PMHNP or FNP) - Behavioral Health - Addiction Treatment Job Category: Medical... ...Director. Participate in case reviews and treatment planning discussions. Order... ...protocols. Provide clinical information to Utilization Review teams to assist with...Daily paidPart timeFlexible hoursWeekend work
- PRIMARY PURPOSE The Behavioral Health Advanced Practice Registered Nurse (Psychiatric APRN) provides... ...Planning & Documentation Develop, review, and update individualized psychiatric... ...FoundCare’s Behavioral Health Protocols. Utilize psychiatric progress notes to document...Work at office
$40 per hour
...Nurse Reviewer PT (20‐30 hours week) – Remote Work Environment Non‐Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer... ...database Evaluate medical claims against industry standards, utilizing research of relevant ICD‐10, CPT, and HCPCS codes to determine...Contract workWork at officeLocal areaImmediate startRemote work$68.13k - $119.52k
...Whole Person Well-being Resources Mental Health Resources and Support Pet Benefits... ...initial and continued stay medical necessity reviews. Maintain thorough knowledge of payer... ...concurrent authorizations for in-house patients, utilizing daily commercial authorization reports....Full timeWork experience placementLocal areaShift work$81k - $90k
...value, transparency, and efficiency to health plans. Deployed by over 75 health plans,... ...settings while applying appropriate medical review guidelines, policies and rules.*... ...and Abilities Needed:*** Experience with utilization management systems or clinical decision-...For contractorsWork at officeRemote workWork from homeHome officeShift work- Overview BayCare Health Systems is currently seeking an experienced Behavioral Health Charge RN to join our outstanding and compassionate team at Integrated Stabilization... ...proficient in the care of a patient population utilizing effective managerial skills. Responsibilities...Full timeShift workNight shiftWeekend work
- Integrated Home Care Services, Inc. is seeking a Utilization Management Nurse in Florida, NY. You will ensure home health care services are delivered efficiently and within compliance, reviewing patient treatment files and certifying medical necessities. Key qualifications...
$71.1k - $97.8k
Job Summary The Utilization Management Registered Nurse uses clinical nursing skills to interpret... ...Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME).... ...experience in utilization management/utilization review for a health plan or acute care setting....Bi-weekly payTemporary workRemote work- A leading behavioral health company is seeking a Licensed Psychologist for various locations in New York. The role involves diagnosing and treating emotional, mental, and behavioral disorders, assessing patients, and providing recommendations for treatments. The ideal candidate...
- ...involves providing direct therapeutic services to individuals facing mental health and emotional challenges. Candidates must have an active LCSW license in Florida, at least 2-3 years of behavioral health experience, and a Master's degree in Social Work. This role offers...Full time
- ...ideal candidate will communicate with hospital physicians and management teams while conducting case reviews to ensure compliance with clinical documentation and utilization standards. Responsibilities include consulting with attending physicians, managing utilization and...
- ...Practical Nurse (LPN) to join their compassionate team. The LPN will utilize nursing processes, coordinate admissions, and manage... ...certification and preferably have experience in nursing and behavioral health. This full-time position offers a competitive total rewards package...Full time
- ..., a long-term acute care facility, home health services, outpatient centers and thousands... ...a field-based role. Facility: BayCare Behavioral Health Urgent Care Location: Pasco... ...Weekend Work: None On Call: No The LPN Utilizes the nursing process: assessing, planning...Full timeShift workWeekend work
- This organization is a technology-driven health insurance company built on a full-stack... ...inpatient, outpatient, and pharmacy services by reviewing clinical information and applying... ...to the Associate Medical Director, Utilization Management. Key Responsibilities Conduct...Weekend work
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