Remote Behavioral Health Utilization Review Specialist
Nationwide-Children
- Remote job
Nationwide Children's Hospital is seeking a utilization review professional to evaluate behavioral health cases, ensuring medical necessity and guideline alignment. You will engage with hospital teams and third-party payors to secure quality care and proper payment. The role involves retrospective reviews, denial management, documentation, and data analysis to improve patient outcomes. After a 90-day in-office training, the position offers remote work from home options. #J-18808-Ljbffr Nationwide-Children
$50k
...Employer Industry: Behavioral Healthcare Management Why consider this job opportunity... ...pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the... ...Qualifications) Bachelor’s degree in a health or behavioral health-related field required...Remote work- 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
- ...FHE Health is seeking an experienced UR Specialist to manage clinical authorizations with insurers, ensuring timely communication and adherence to payer... ...Join a team focused on compliant, high-quality care in behavioral health, with responsibilities centered on maximizing...Remote work
- ...FHE Health Job OpportunityFHE Health is a nationally recognized behavioral healthcare institution that delivers quality, medically... ...are seeking an experienced specialist who is passionate about... ...required preferred.2-3 years of utilization review experience in behavioral...Remote workDaily paidFull time
- Nationwide Children’s Hospital is seeking a Behavioral Health Utilization Review Specialist to review cases, determine medical necessity, and ensure compliance with guidelines. The role conducts pre-certifications, pre-authorizations, and retrospective reviews, collaborating...Remote jobWork at officeWork from home
- ...mattersMesa Springs is part of Lifepoint Health, a diversified healthcare delivery... ...exceptional care to others. As a Utilization Review Specialist joining our team, you're embracing a... ...about Mesa SpringsMesa Springs is a behavioral health hospital offering exceptional...Temporary workPart timeRelief
- ...matters Mesa Springs is part of Lifepoint Health, a diversified healthcare delivery... ...exceptional care to others. As a Utilization Review Specialist joining our team, you're embracing a... ...about Mesa Springs Mesa Springs is a behavioral health hospital offering exceptional...Temporary workPart timeRelief
- ...Mesa Springs is part of Lifepoint Health, a diversified healthcare delivery network... ...exceptional care to others. As a Utilization Review Specialist joining our team, you're embracing a... ...about Mesa Springs Mesa Springs is a behavioral health hospital offering exceptional...Temporary workPart timeRelief
- FHE Health in Florida seeks an experienced UR Specialist who will manage clinical authorization processes with insurance... .... You will support access to behavioral health treatment and maximize... ...related field and 2-3 years of utilization review experience in behavioral health...Daily paid
- ...Alliance Health is seeking a UM Clinical Specialist-LTSS for full-time remote work, NC-based. You will perform utilization reviews and authorizations for I/DD and TBI waivers, ensuring services meet clinical guidelines and are provided in the least restrictive setting....Remote workFull time
- ...Recruiting is assisting a highly awarded health system north of Philadelphia, PA, in... ...Medicine physician for a non-clinical utilization review role. The position offers a daytime schedule... ...through Friday with the potential for remote work part of the time. Salary with...Remote workPart timeMonday to Friday
$27.02 - $48.55 per hour
...: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors... ...flexibility to work remotely from their home... ...Performs concurrent review of behavioral health (BH) inpatient... ...quality and appropriate utilization of services Provides...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hours$32.65 - $43.9 per hour
...revenue cycle management solutions for health systems, including hospitals and... ...needed. We are seeking Virtual Utilization Review Specialists to join our team. Essential job function... ...Abilities Required: This is a remote role which requires access to high...Remote workTemporary workWork at officeLocal area- ...R1 RCM is seeking an experienced Utilization Review Author (RN) for our Physician Advisory Team. The role involves first-level admission and continued stay reviews using InterQual/MCG criteria and requires hospital-based UR or Case Management experience. The position...Remote workFlexible hours
- ...HealthHelp is seeking a remote Utilization Review clinician (RN/LPN/LVN) to support medical necessity determinations across client programs. You will review cases, coordinate with providers, and ensure timely decisions in line with policy and regulatory requirements. Ideal...Remote workWork at office
- ...Ascension Sacred Heart Hospital is seeking a nurse to join our Utilization Management team in a remote role. You will perform prospective, concurrent, and retrospective reviews to ensure medical necessity and alignment with reimbursement policies. Join a multidisciplinary...Remote work
- ...Job Description Job Description Behavioral Health Utilization Management Specialist Location: Utah (Hybrid & Remote Options Available) Job Type: Full-time Department... ...You’ll Do Champion patient care by reviewing medical records and clinical documentation...Remote workFull timeWork at office
- ...Mesa Springs in Fort Worth, TX is seeking a dedicated Utilization Review Specialist to ensure appropriate inpatient and outpatient authorizations, accuracy in denials and certifications, and effective communication with physicians and care teams. You will apply clinical...
- UnitedHealth Group in California offers a remote-capable role focusing on behavioral health case management. You will handle inbound calls from providers... ...2+ years of experience. The role emphasizes timely utilization management, benefits explanation across levels of care...Remote job
- 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
$62k - $70k
...Description Why Charlie Health? Millions of people... ...lacks personalization, behavioral healthcare can leave... ...is to ensure that the utilization process is thorough, organized... ...peer to peer reviews with insurance MDs to... ...sponsored benefits. #LI-REMOTE Please note that this...Remote workFull timeLocal area- HonorHealth in Arizona seeks an Utilization Review RN Specialist to review and monitor utilization for cost-effective, high-quality care. This role... ...and a strong collaboration with physicians and care teams. Remote work is available after training. #J-18808-Ljbffr...Remote job
- Centene is seeking a Utilization Review Clinician to assess mental health and substance use care across the continuum. Two schedules are available, with 10... ...times: 8:00 or 9:00 AM ET. Requires RN or Master’s in Behavioral Health, 2-4 years of related experience, and...Remote jobShift work
- Ampcus Inc. is seeking a Utilization Management Specialist (Remote) to review medical necessity and authorization for clinical services. The role emphasizes clinical nursing expertise, care management experience, and adherence to guidelines and policies. The position requires...Remote job
- Evolve Treatment Centers in West Palm Beach, Florida, is seeking a full-time Utilization Review Specialist. This role involves initiating pre-certification authorizations, communicating with facilities, and maintaining patient census. Candidates should have a High School...Full time
- Mesa Springs, part of Lifepoint Health, seeks an Utilization Review Specialist to support inpatient and outpatient coverage decisions. You will validate criteria, complete certifications, report denials, and collaborate with clinicians to secure appropriate services. The...
- Memorial Physician Practices is hiring a Utilization Review Specialist in Tucson, Arizona, who will facilitate clinical reviews and advocate for patients accessing mental health services. This PRN role involves working with managed care organizations and is vital for ensuring...Relief
$29.62 - $45.31 per hour
...Description Providence Health Plan caregivers are not simply valued – they’re invaluable... ...Department Coordinate and execute the review and research functions required to... ...inquiries, provider resolutions, etc.) Remote Work This position offers 100% remote...Remote workMinimum wageFull timeWork experience placementLocal areaShift work- ...purpose-driven leadership. At Bradford Health Services, we are committed to... ...digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching... ...people. About the Role: The Utilization Review Specialist plays a critical role in ensuring...Remote workPart time
- ...ABA Utilization Review SpecialistSpectrum Billing Solutions offers industry... ...Utilization Review (UR) Specialist to our growing team. The... ...environment. This is a fully remote or office/home hybrid... ...years of related ABA and/or Behavioral Health experience.Bachelor's or master...Remote workWork at officeFlexible hours
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