Remote Behavioral Health Utilization Reviewer
Gainwell Technologies
Gainwell Technologies is seeking a Behavioral Health Prior Authorization reviewer to adjudicate submissions for Substance Use Disorder Treatment, Child and Adolescent Day Treatment, and Adult Mental Health Day Treatment. This 100% remote role involves utilization review and quality assurance with no direct patient contact. You will review submissions, enter outcomes in MMIS, and participate in stakeholder meetings, ensuring compliance with state policies and best practices. #J-18808-Ljbffr
- Comagine Health is seeking a Clinical Reviewer to work remotely from Oregon with travel across the Eugene and surrounding areas. You will... ..., 3 years of direct patient care in behavioral health, and familiarity with utilization review. #J-18808-Ljbffr Comagine HealthRemote job
- ...Umpqua Health is seeking an Utilization Review Clinician to perform clinical reviews for mental health and substance use services. This remote role may require on-site travel to Roseburg, OR as needed and offers a full-time exempt schedule. The URC collaborates with care...Remote workFull time
- ...Comagine Health is seeking a Behavioral Health Reviewer based in Oregon. Responsibilities include reviewing clinical documentation for medical necessity, conducting assessments, and managing referrals in a remote capacity. Applicants should possess a relevant master's...Remote work
$130 - $145 per hour
...Job Description Hi, we're Oscar. We're hiring a Behavioral Health Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance... .... Work Location: This position is fully remote and open to candidates residing in the U.S.,...Remote workHourly payFull timePart timeWork from homeHome office- ...coordinating, integrating, and monitoring the utilization of behavioral health (BH) or physical health (PH) services... ...cases to the Medical Director for review. Refer to and work closely with Case... .... Please note: The opportunity for remote work may be possible for all jobs...Remote workContract workWork at office
- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board certification and unrestricted medical license in relevant states. The role involves performing detailed...Remote workFull timeWork from home
- ...Blue Cross Blue Shield of Massachusetts, Inc. is seeking a Clinical Utilization Reviewer to support members with complex health needs by authorizing appropriate services and promoting high-quality care. The role blends independent work with team collaboration to apply...
- ...IntePros is seeking a Physician Reviewer to provide remote support for a healthcare organization. The... ...Medicine, preferably with experience in health insurance. This position offers a... ...opportunities to leverage clinical expertise in utilization management. #J-18808-Ljbffr...Remote work
- ...organization is seeking experienced Physician Reviewers to join their Medicare Utilization Management team in a remote position. Responsibilities include reviewing clinical... .... A comprehensive benefits package including health plans and 401(k) is offered, promoting equality...Remote work
- ...A leading independent review organization is seeking a Utilization Management Physician Reviewer for a full-time remote role. Candidates must possess an active Nebraska medical license and have a minimum of 5 years clinical practice experience. Responsibilities include...Remote workFull timeCasual workMonday to Friday
- ...Oak Street Health is seeking a Full-Time Utilization Management Physician Reviewer to provide accurate coverage determinations for inpatient and outpatient services, applying UM criteria, clinical judgment, and internal policies. You will coordinate with care teams to...Remote workFull time
- A recognized healthcare provider is seeking a Board Certified Orthopaedic Spine Surgeon to conduct utilization reviews. This telework position allows for a flexible schedule within a standard Monday - Friday work week. Responsibilities include reviewing medical records,...Remote workFor contractorsMonday to FridayFlexible hours
- ...Dane Street, a certified "Great Place to Work" company is seeking a Physician to provide utilization review services for the Group Health Department. This role requires utilizing clinical expertise to review medical records and provide an interpretation of the medical...Remote work
$35 - $40 per hour
...containment, and analytics. Job Title RN Utilization Management Reviewer Responsibilities Conduct timely... ...Medicare Part B medications, LTSS, and Home Health. Apply established criteria (e.g.,... ...require weekends. Location: Fully remote work at home role. Secure, private area...Remote workHourly payTemporary workMonday to FridayFlexible hoursWeekend work- Elevance Health is seeking a Psychologist Reviewer - ABA for virtual/remote work with in-person onboarding. You will collaborate with providers and Medical Directors... ...psychology and an active license; 2+ years in behavioral health preferred. #J-18808-Ljbffr Elevance HealthRemote job
- ...physician with strong clinical and UM background to cover delegated utilization management across multiple territories. The role requires... ..., and 2+ years in hospital medicine, with utilization review experience preferred. You will coordinate with PCP/SNF meetings...Remote job
- ...Orthopedic Spine Surgeon Reviewer Dane Street, a nationally recognized Independent Review Organization (IRO), is... ...Workers' Compensation Board Certification to conduct Utilization Reviews. This is a fully remote, non-clinical role offering supplemental income with...Remote workPrice workExtra incomeFor contractorsFlexible hours
- tango is seeking a Physician Reviewer to join our remote, full-time team. You will perform real-time utilization management case reviews, apply evidence-based guidelines, and... ...to determine medical necessity for home health services. You will collaborate with provider...Remote jobFull timeFlexible hours
$27.02 - $48.55 per hour
...Purpose: Performs a clinical review and assesses care related to mental health and substance abuse.... ...flexibility to work remotely from their home anywhere... ...concurrent review of behavioral health (BH) inpatient to... ...quality and appropriate utilization of services Provides...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hours- ...Centene Management Company LLC is seeking a remote Utilization Review Clinician – Behavioral Health to support our Behavioral Health Medicare Plan. You will perform medical necessity reviews and authorization determinations to help ensure members receive appropriate, high...Remote workMonday to Friday
- Point32Health in Massachusetts seeks a Behavioral Health Utilization Management Clinician to conduct benefit coverage reviews and clinical determinations under supervision within... ...while maintaining regulatory compliance. Remote work as required with a fast-paced environment...Remote job
- FHE Health is seeking a Utilization Review Specialist to manage clinical authorization processes and coordinate with insurance payers for timely authorizations... ...candidate should have 2-3 years of UR experience in behavioral health, with strong ASAM criteria knowledge and...Remote job
- Sentara Health in Richmond, VA is hiring a Behavior Health Utilization Management Care Coordinator to support members who are medically and behaviorally complex. The role requires both in-person assessments and remote telephonic assessments for serious mental illness, SED...Remote work
$86k - $117.3k
...For roles that are 100% remote or hybrid, you must have access... ...the nation's leaders in health care solutions, we offer... ...specialty pharmacy services, behavioral health services, and other... ...of a supervisor, the Utilization Management Reviewer evaluates medical necessity...Remote workHourly payContract workMonday to FridayFlexible hoursWeekend work- Sentara Health Plan PG in the United States seeks a Behavior Health Utilization Management Care Coordinator to work with medically and behaviorally complex members. The... ...both in-person face-to-face assessments and remote telephonic assessments for SMI, SED (ages 2+),...Remote work
$87.7k - $157.8k
...Authorize, direct and monitor care for behavioral health and/or substance abuse problems... ...Key Details: Centene is seeking Remote Psychologist Reviewers (Applied Behavior Analysis).Candidates... ...on best practice models and utilization management processes ~ Interact...Remote workFull timePart timeWork at officeFlexible hours- ...Corporation is seeking a clinical reviewer to assess mental health and substance use care, determine... ...necessity, and support appropriate utilization. Remote work within the Central Time Zone... ...required licenses, and a Master’s in behavioral health for #J-18808-Ljbffr...Remote jobMonday to Friday
- Centene is seeking an Inpatient Utilization Review Clinician for Behavioral Health to perform clinical reviews and assessments ensuring appropriate care for... ...coordination of care across providers. The position offers remote flexibility with a 8am-5pm schedule on days (Tuesday-...Remote jobWeekend work
$86k - $154.7k
...for the Psychologist Reviewer role at RemoteWorker US... ...our Medical Management/Health Services team. Centene... ...Centene is hiring a Remote Psychologist - Join Our... ...for improving access to behavioral health care? Centene... ...well as participating in Utilization Management clinical...Remote workFull timeWork at officeRelocation packageFlexible hours$140 - $145 per hour
...Description Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management Team. Oscar is the first health insurance company built around a full stack... ...Management. Work Location: This is a remote position, open to candidates who reside in the...Remote workHourly payFull timePart timeLocal areaWork from homeHome officeWeekend work
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