Behavioral Health Utilization Review Clinician
Molina Healthcare
Molina Healthcare is seeking a Behavioral Health Utilization Reviewer to support member clinical service reviews for behavioral health. Responsibilities include verifying medical necessity, ensuring alignment with guidelines and policies, and contributing to the delivery of integrated care across the continuum to improve outcomes and cost-effectiveness. The role involves collaboration with multidisciplinary teams, adherence to UM policies, and potential involvement in ABA/BHT services for ASD. #J-18808-Ljbffr Molina Healthcare
- ...military spouses. This internship will involve conducting clinical reviews, communicating with healthcare providers, and documenting... ...license in Kentucky and have at least two years of clinical behavioral health experience. The role is remote, focusing on healthcare...SuggestedInternshipRemote work
- ...Overview Job Summary: Provides support for clinical member services review assessment processes. Responsible for verifying that services... ...teams to promote the Molina care model. Adhere to utilization management (UM) policies and procedures. Required Qualifications...SuggestedWork at office
$10k
## Utilization Review RN - PT - Day - Utilization Resource Mgmt Pennington NJApplylocations: Pennington... ...requisition id: JR109737Capital Health is the region's leader in providing... ...familiarity with MCG guidelines. Mental, Behavioral and Emotional Abilities: Ability to...SuggestedFull timeTemporary workPart timeWork at officeLocal areaImmediate startFlexible hoursNight shift- Santa Barbara Cottage Hospital is looking for a Utilization Review Clinician to ensure that medical necessities are reviewed effectively. This role involves collaboration with physicians and healthcare providers to manage patient care through established guidelines. The...Suggested
$66.3k - $79.8k
...the full array of necessary physical and behavioral health services and other community-based... ...Community of Professionals What You Will Do Utilizes approved assessments to identify... ...plans. Facilitates periodic case record reviews and case conferences with all providers...SuggestedTemporary workWork experience placementFlexible hours$66.3k - $79.8k
...array of necessary physical and behavioral health services and other community... ...general supervision. • Utilizes approved assessments to identify... ...periodic case record reviews and case conferences with all... ...with physicians and evaluating clinicians for additional medical or mental...Temporary workWork experience placement- ...array of necessary physical and behavioral health services and other community... ...under general supervision. Utilizes approved assessments to... ...Facilitates periodic case record reviews and case conferences with... ...with physicians and evaluating clinicians for additional medical or...Daily paidTemporary workWork experience placement
$66.3k - $79.8k
...the full array of necessary physical and behavioral health services and other community-based... ...Professionals What You Will Do ~ Utilizes approved assessments to identify... ...plans. Facilitates periodic case record reviews and case conferences with all providers...Temporary workWork experience placementFlexible hours- ...You’ll Work Hello humankindness Dignity Health’s Mercy Gilbert Medical Center is nationally... ...Job Summary and Responsibilities As our Utilization Management Nurse, you will be a critical... .... Every day, you will meticulously review medical records, authorize services, and...
- ...A healthcare staffing firm is seeking a skilled Utilization Review RN to join their team. This fully remote position requires a valid PA RN license and prior experience in insurance utilization review. Responsibilities include conducting clinical reviews, applying evidence...Remote work
- ...Medix™ is seeking an experienced RN for a Utilization Review role, allowing you to work from the comfort of home. In this contract-to-hire position, you'll review inpatient treatment plans and communicate with medical teams to ensure appropriate care levels. Ideal candidates...Contract workRemote workWork from home
$23.76 - $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...Hourly payWork experience placementWork at office- ...Friday, 9:00 AM - 5:00 PM Overview We are seeking a Behavioral Health Utilization Management (BH UM) Clinician to support utilization and quality management... ...through prospective, concurrent, and retrospective reviews. Key Responsibilities Conduct telephonic utilization...Contract workMonday to Friday
- Elevance Health is seeking a qualified clinical professional to manage moderately complex cases related to benefit plans. The role requires... ...week. Candidates will be responsible for conducting treatment reviews and collaborating with healthcare providers to ensure...Remote job1 day per week
- A healthcare organization is seeking a Behavioral Health Utilization Management (BH UM) Clinician in New York City. This role emphasizes the management of healthcare... ...while ensuring high-quality care through various reviews. Candidates should have a Master’s Degree and at...
$65 per hour
...manage resources, and ensure appropriate utilization of healthcare services while maintaining... ...discharge planning. Conduct utilization review to ensure appropriate level of care and... ...planning and patient advocacy Benefits Pride Health offers eligible employees comprehensive...Hourly payWeekly payLocal areaShift work$35 - $45 per hour
...IntePros IntePros is seeking a Remote Utilization Review Nurse serves as a key clinical liaison... ...determine the need for continued home health services in alignment with Medicare guidelines... ...requirements. Provide feedback to clinicians on accurate assessments, homebound...Contract workRemote workWeekend work$45k - $70k
...A leading healthcare company is looking for a Utilization Management Nurse Reviewer to ensure medical services are appropriately utilized. Responsibilities... ...from $45,000 to $70,000, with benefits including health insurance, paid time off, and a 401k plan. #J-18808-Ljbffr...Remote work$75k
...Santa Barbara Cottage Hospital is seeking a dedicated Registered Nurse for inpatient utilization review responsibilities. This role requires performing medical necessity reviews and collaborating with clinical teams to make informed decisions. Candidates must hold an...Remote work- ...A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare... ...license and have experience in utilization review or home health. This contract role offers a chance to manage healthcare...Contract workRemote work
$30 - $38 per hour
...A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Hourly payPart timeRemote work$18k
...excellent career opportunities. For more than 50 years, Dignity Health’s Chandler Regional Medical Center has focused on quality... ...Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of...Full timePart timeLive out- ...Currently seeking a Utilization Management RN . Please see details and qualifications below: Position is remote - candidate must reside... ...evaluate members’ clinical conditions through medical record review to determine medical necessity for services. Using advanced...Immediate startRemote workDay shift
- ...Job Title RN-Utilization Review Nurse (Hybrid, Inpatient) Overview VillageCare is looking for a self‑motivated and passionate RN as Utilization... ...solutions that promote high quality and cost‑effective health care services. Responsibilities Review planned, in‑process, or...Full timeWork from home
$57.24k - $62.18k
...Santa Barbara Cottage Hospital is seeking a Registered Nurse with Mental Health and/or Substance Abuse experience. This Monday to Friday position offers a work-life balance with no nights, weekends or holidays, and up to 50% remote work after training. The ideal candidate...Remote workMonday to FridayWeekend work$85k - $105.34k
...Utilization Review Nurse Remote; Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, as needed for business operations. Employment... ...across care settings, ensuring compliance with Oregon Health Plan (OHP), Medicare, and applicable regulations. The UM...Full timeWork at officeLocal areaImmediate startRemote workMonday to Friday$35 - $43 per hour
...35.00/hr - $43.00/hr Job Title Clinical Review Nurse – Concurrent Review Location: Remote... ...Nurse – Concurrent Review will perform utilization management functions to ensure members... ...discharge plans, and medical determinations in health management systems. Educate providers on...Remote work$45k - $70k
...healthcare company in the United States is looking for a Utilization Management Nurse Reviewer to ensure the efficient use of medical services and... ...$70,000 and a comprehensive benefits package including health insurance, retirement plans, and paid time off. The role...Remote work$45k - $70k
...A healthcare services company is seeking a Utilization Management Nurse Reviewer to ensure medical services are used appropriately. The role involves reviewing medical records and coordinating care while adhering to guidelines. Candidates should possess an unrestricted...Remote work- ...A leading healthcare solutions company is seeking an experienced Utilization Review Nurse to improve patient care through home-based services. Responsibilities include processing authorization requests, ensuring compliance with Medicare guidelines, and collaborating with...Remote work
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