Remote Behavioral Health Utilization Reviewer
Comagine Health
- Remote job
Comagine Health is seeking a Clinical Reviewer to work remotely from Oregon with travel across the Eugene and surrounding areas. You will review clinical documentation to determine medical necessity and coordinate assessments via EMR systems, ensuring timely decisions and high-quality care. The role requires licensure, 3 years of direct patient care in behavioral health, and familiarity with utilization review. #J-18808-Ljbffr Comagine Health
- Comagine Health is seeking a remote clinical reviewer to evaluate medical necessity for behavioral health services across a national footprint. The role requires applying evidence-based criteria, managing high-volume reviews, and documenting outcomes within the EMR. You...Remote jobFull time
- 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 jobFull 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 degree...Remote job
$130 - $145 per hour
Hi, we're Oscar. We're hiring a Behavioral Health Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around... ...Management. Work Location: This position is fully remote and open to candidates residing in the U.S.,...Remote workHourly payPart 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... ...note: There may be opportunity for remote work within all jobs posted by the...Remote workContract workWork at office
$219k - $286.9k
...Physician Reviewer - Utilization Management Remote 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 technology platform and a relentless focus on serving...Remote workFull timeLocal areaWork from homeHome officeWeekend work- 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 jobFull timeWork from home
$219k - $286.9k
Oscar Health is hiring a Physician Reviewer to join our Utilization Management team. You will determine the medical appropriateness of inpatient, outpatient, and... ...information and applying evidence-based guidelines. This remote role in the United States offers work from home...Remote jobWork from home- Nationwide Children's Hospital is seeking a utilization review professional to evaluate behavioral health cases, ensuring medical necessity and guideline alignment... ...a 90-day in-office training, the position offers remote work from home options. #J-18808-Ljbffr Nationwide...Remote jobWork at officeWork from home
- 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
$174.07k - $374.92k
...Full-Time Utilization Management Physician Reviewer We're building a world of health around every individual — shaping a more connected, convenient and compassionate... ...time. Company: Oak Street Health Location: Remote/ Treehouse Role Description: This full-...Remote workHourly payFull time- ...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
- 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 ensure...Remote jobFull time
- ChenMed LLC is seeking a Physician Reviewer to lead delegated utilization management (UM) reviews across multiple markets. You will establish daily case counts, attend essential calls with health plans, advise other reviewers, and participate in ongoing process and quality...Remote job
- ...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 job
- 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 jobFull timeCasual workMonday to Friday
- 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 jobFor contractorsMonday to FridayFlexible hours
$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- 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
$65k - $88.6k
...Become a part of our caring community The Utilization Management Behavioral Health Professional uses behavioral health knowledge and skills to support... .../ HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday$60.52k - $129.62k
...Care Plan Reviewer (Clinical Case Manager BH) We're building a world of health around every individual — shaping a more connected... ...(Clinical Case Manager BH) utilizes advanced clinical judgment and... ...supports appropriate member behavioral healthcare through review of...Remote workHourly payFull timeTemporary workLocal area- 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
- ...Role Overview Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient... ...independently applies medical and behavioral health guidelines to authorize services,... ...Flexible work solutions include remote options, hybrid work schedules, competitive...Remote workMonday to FridayFlexible hoursWeekend work
- CVS Health is hiring a Behavioral Health Utilization Management Clinician for a fully remote, nationwide role. You will evaluate preauthorization requests, coordinate decisions with providers, and manage crisis calls when needed. Ideal candidates will hold an active BH...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
$87.7k - $157.8k
...on our Medical Management/Health Services team. Centene is... ...Description Centene is Hiring – Remote Psychologist Reviewers (ABA) Centene is seeking... ...Reviewers (Applied Behavior Analysis). Candidates... ...best practice models and utilization management processes Interact...Remote workFull timePart timeWork at officeFlexible hours- 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 - $154.7k
...for the Psychologist Reviewer role at RemoteWorker... ...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- 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
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