Senior Behavioral Health Utilization Review Clinician

Blue Shield of CA

Blue Shield of CA in Miami is seeking a Senior Behavioral Health Utilization Management Clinician to join their team. This role involves conducting clinical reviews for mental health and substance use authorizations, ensuring compliance with multiple guidelines and policies. The ideal candidate will have at least five years of relevant experience, a current CA license, and strong analytical and communication skills. The position offers a hybrid work environment, allowing for virtual work based on business needs. #J-18808-Ljbffr

Apply

Vacancy posted 1 day ago

Similar jobs that could be interesting for youBased on the Senior Behavioral Health Utilization Review Clinician in Doral, FL vacancy

Behavioral Health Utilization Mgmt Clinician, Senior
...Your Role The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced... ...Behavioral Health Utilization Management Clinician, Senior, will report to the Manager of...
Senior
Full time
Contract work
Work at office
Blue Shield of CA
Doral, FL
1 day ago
Senior Medical Management Clinician - Remote RN/LPN
...Elevance Health is seeking a Medical Management Clinician Senior to manage complex cases and oversee clinical information assessments. The position requires a minimum of 6 years of clinical or utilization review experience and active LPN/LVN or RN licensure. This role...
Senior
Remote work
Elevance Health
Doral, FL
1 day ago
Care Review Clinician, ABA
$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...
Suggested
Hourly pay
Work experience placement
Work at office
Local area
Molina Healthcare
Doral, FL
2 days ago
Care Review Clinician, ABA
$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...
Suggested
Hourly pay
Contract work
Work experience placement
Work at office
Local area
Molina Healthcare
Miami, FL
6 days ago
Health Care Provider LPN
...Care Review Clinician Integrated Resources, Inc is a premier staffing firm recognized as... ...Description Summary: Works with the Utilization Management team primarily responsible... ...of care for members including Behavioral Health and Long Term Care. Maintains department...
Suggested
Work at office
Careers Integrated Resources Inc
Miami, FL
4 days ago
RN Care Review Clinician - Utilization & Prior Auth
$26.41 - $61.79 per hour
...Uloop Inc. is looking for a Clinical Reviewer in Miami, Florida, to provide support for clinical member services review assessment processes. Responsibilities include assessing services, analyzing clinical requests, and ensuring compliance with guidelines. The ideal candidate...
Hourly pay
Uloop
Doral, FL
1 day ago
Utilization Review Nurse Appeals & Medical Claims
...Molina Healthcare is seeking a Registered Nurse for clinical review in Miami, Florida. This role involves ensuring medical necessity... ...have 2+ years in clinical nursing, including experience in utilization review. Skills in coding and regulatory compliance are essential...
Molina Healthcare
Doral, FL
1 day ago
Medical Management Clinician Senior -Licensed Nurse
Medical Management Clinician Senior -Licensed Nurse Location: Tampa, FL... ...administration of plan benefits by reviewing clinical information and... ...and effectiveness of the utilization reviews within the medical management... ...customers to help improve health outcomes for members....
Senior
Full time
Contract work
Local area
Elevance Health
Miami, FL
2 days ago
ABA Care Review Clinician - Health Care Utilization Expert
$26.41 - $51.49 per hour
Molina Healthcare seeks a Candidate to provide support for member clinical reviews related to ABA services. Responsibilities include assessing ABA services for compliance, analyzing requests, and collaborating with care management. Required qualifications include adequate...
Hourly pay
Molina Healthcare
Miami, FL
4 days ago
Senior Health Educator- Pediatric Mental Health Nurse - Remote
...Title Pediatric Mental Health Nurse Job Summary Provides senior level support for health... ...position is focused on behavioral health and is seeking a... ...the annual work plan. • Reviews and updates health education... ...functionality of all utilized databases. • May serve...
Senior
Contract work
Work at office
Local area
Remote work
Night shift
Molina Healthcare
Miami, FL
4 days ago
Nurse Audit Senior (Operating Room)
$82.19k - $123.29k
...Nurse Audit Senior (Operating Room) Virtual: This... ...member of the Elevance Health family of companies,... ...aberrant patterns of utilization and/or fraudulent activities... ...prepayment claims review, post payment auditing... ...associates. Our values and behaviors are the root of our...
Senior
Full time
Temporary work
Work experience placement
Local area
1 day per week
Carebridge Corporation
Miami, FL
2 days ago
Nurse Audit Senior - Operating Room
...Title: Nurse Audit Senior - Operating Room Job Description... ...aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment claims review, post payment auditing,... .... Our values and behaviors are the root of our culture...
Senior
Full time
Temporary work
Work at office
Local area
Monday to Friday
Shift work
Day shift
1 day per week
Elevance Health
Miami, FL
7 days ago
Remote Ortho Physician Reviewer | Utilization Management
...ChenMed is looking for a Licensed Physician Reviewer – Ortho for a remote role based in Miami, FL. This position involves conducting Utilization Management reviews and advising other physician reviewers while participating in quality improvement efforts. The ideal...
Remote work
ChenMed
Doral, FL
4 days ago
Senior registered nurse - home health
...Senior Registered Nurse Integrated Resources, Inc is a premier... ...completing medical necessity reviews using KFHP policies and procedures... ...Consistently applies medical health benefit policy and medical... ...received, nature of request, utilization determination (and events...
Senior
Careers Integrated Resources Inc
Miami, FL
4 days ago
Weekend Matron
...for a faculty or staff position, please review this tip sheet. The University of Miami has a great opportunity for a Nurse Utilization Review Supervisor to work at UTower. POSITION... ...activities to appropriate members of the health care team, documenting treatment plan,...
Full time
Temporary work
Worldwide
Night shift
Weekend work
The University of Miami
Miami, FL
3 days ago
Senior Clinical Appeals Reviewer
Senior Clinical Denials Coordinator page is loaded## Senior Clinical... ...our legacy in high-quality health care.**Since 1949, Mount... ...serves as a Clinical Denials Unit Reviewer responsible for managing and... ...management, clinical denials appeals/ utilization management or related field.*...
Senior
Contract work
Work at office
Mount Sinai Medical Center of Florida, Inc.
Miami, FL
3 days ago
Remote position- Senior Care Manager-RN,
...Remote position - Senior Care Manager - RNFull-timeIntegrated Resources, Inc., is led by a seasoned team with decades of industry... ...access preferred.CCM or CCP certification preferred.Experience in utilization review, concurrent review, or risk management is a plus.All...
Senior
Permanent employment
Temporary work
Work at office
Local area
Remote work
Integrated Resources
Doral, FL
2 days ago
Care Review Clinician (RN)
$26.41 - $61.79 per hour
...Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are... ...multidisciplinary teams to promote the Molina care model. Adheres to utilization management (UM) policies and procedures. Required...
Hourly pay
Work experience placement
Work at office
Uloop
Doral, FL
1 day ago
BEHAVIORAL HEALTH CLINICIAN
...Job Description Job Description BEHAVIORAL HEALTH CLINICIAN Professional Full Time Exempt The Behavioral Health Clinician performs mental... ..., and family histories, by interviewing patients and by reviewing records. Provide psycho education to patients around...
Full time
Camillus Health Concern
Miami, FL
26 days ago
RN Care Review Clinician (FL) Utilization & Prior Auth
$26.41 - $51.49 per hour
Molina Healthcare is looking for a dedicated professional to provide support for clinical member services in Miami, Florida. The role involves assessing services for compliance and optimal outcomes, analyzing service requests, and collaborating with clinical teams. A valid...
Hourly pay
Molina Healthcare
Doral, FL
5 days ago
Senior Care RN
...Senior Registered Nurse Supv This is a responsible administrative... ...to the Executive Community Health Nursing Director position.... ...include: Planning: Collects, reviews, and provides CMAT program... ...quality improvement plans, utilizing the Plan, Do, Study, Act (PDSA...
Senior
Work at office
Florida Jobs
Miami, FL
6 days ago
Senior Research Lead, Behavioral Health Studies
...1 to join the UHealth medical campus in Miami, FL. This role offers the chance to lead and coordinate complex community-based behavioral health research studies. The Sr. Research Associate will manage research protocols, mentor junior staff, and ensure data quality while...
Senior
Full time
University of Miami
Miami, FL
4 days ago
Care Review Clinician (RN) - Remote in FL
$26.41 - $51.49 per hour
...Florida Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services... ...teams to promote the Molina care model. Adheres to utilization management (UM) policies and procedures. Required Qualifications...
Hourly pay
Work experience placement
Work at office
Remote work
Molina Healthcare
Doral, FL
3 days ago
Nurse Reviewer I
$33.92 - $58.15 per hour
...Nurse Reviewer I Virtual: This role enables associates... ...of the Elevance Health family of companies, is... ...—connecting physical, behavioral, social, and pharmacy... ...diagnostic imaging services by utilizing appropriate policies,... ...guidance by more senior colleagues and/or management...
Full time
Work experience placement
Work at office
Local area
Elevance Health
Doral, FL
6 days ago
Senior Clinician & Team Lead
...A non-profit organization supporting individuals experiencing homelessness in Miami is seeking a Clinician III to oversee clinical operations and supervise junior staff. The ideal candidate will possess a Master’s degree in a relevant field and an active Florida license...
Senior
Camillus House
Doral, FL
1 day ago
Senior Clinical Appeals Reviewer
...Denials Coordinator serves as a Clinical Denials Unit Reviewer responsible for managing and appealing level‑of‑... ...in case management, clinical denials appeals/utilization management, or a related field. Benefits Health benefits Life insurance Long‑term disability coverage...
Senior
Contract work
Work at office
Mount Sinai Medical Center
Miami Beach, FL
13 hours ago
Stop Loss Group Underwriter Consultant, Senior
$107.98k - $169.33k
...Underwriter Consultant, Senior Location: This... ...prospective business utilizing a combination of other... ...Performs post-sale reviews. Prepares or supervises... ...your salary, Elevance Health offers benefits such... .... Our values and behaviors are the root of our culture...
Senior
Temporary work
Work experience placement
Work at office
Local area
2 days per week
1 day per week
Elevance Health
Miami, FL
6 days ago
Clinician, Orthodox Community Behavioral Health
...Jewish Community Services of South Florida (JCS) is looking for a Clinician to provide direct services to individuals and families in the Yehi Ohr behavioral health program. This role requires managing a diverse caseload through in-person and telehealth sessions while...
Jewish Community Services of South Florida
Doral, FL
1 day ago
SENIOR VOCATIONAL REHAB COUNSELOR
$3,986.67 per month
...Education Working Title: SENIOR VOCATIONAL REHAB... ...maintain goal-directed behavior and performance... ...liaison with employers. Utilizes the resources of community... ...results are received, reviewed, and approved by the Department... ...credits per month ~ Health Insurance for...
Senior
Full time
Work experience placement
Self employment
Work at office
Local area
State of Florida
Miami, FL
6 days ago
Senior Product Analytics & AI Consultant
...Senior Product Analytics & AI Consultant Location... ...ROI, cost, quality, utilization, and member outcomes... ...experience in related health care analytics; or any... ...associates. Our values and behaviors are the root of our... ...under Florida law should review the education and...
Senior
Temporary work
Work at office
Local area
2 days per week
1 day per week
Elevance Health
Miami, FL
4 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Senior Behavioral Health Utilization Review Clinician. Be the first to apply!