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$27.02 - $48.55 per hour
...Utilization Review Clinician – Behavioral Health Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically...SuggestedHourly payFull timePart timeWork at officeRemote workMonday to FridayFlexible hoursCentene Corporation
United States4 days ago- Centene is seeking a Utilization Review Clinician to assess mental health and substance use care across the continuum. Two schedules are available, with 10-hour shifts, in Central or Eastern Time Zones. Start times: 8:00 or 9:00 AM ET. Requires RN or Master’s in Behavioral...SuggestedRemote jobShift work
- ...Utilization Review Specialist Senior At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of...SuggestedReliefWeekend 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...SuggestedRemote work
Medix
United States4 days ago - ...and supervises data management, analyses and reporting for KFH utilization management and Continuing Care Services, SCPMG, KFHP Outside... ...utilization at Outside facilities, and the Emergency Prospective Review Program and Air & Ground Transportation Program, using (...SuggestedContract workTemporary workPart timeShift workAfternoon shift
Kaiser Permanente
Downey, CA4 days ago $20 - $36 per hour
...Utilization Review Lvn NurseExplore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team...SuggestedHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaUnitedHealthcare At Home
Pearland, TX4 days ago- Registered Nurse (RN) - Utilization Review Job Description Job Shift:Days Job Type:Full Time The individual in this position is responsible to facilitate effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization...SuggestedFull timeWork at officeRemote workFlexible hoursShift work
$2,110 per week
...Health Advocates Network is urgently hiring Utilization Review Registered Nurses (RNs) in the Fort Myers, FL area. Must have 2 years Utilization Review experience. ~ Pay Rate: $2,110 weekly ~ Specialty: Utilization Review Registered Nurse (RN) ~ Shift: Day ~13...SuggestedWeekly payDaily paidTemporary workLocal areaImmediate startShift workHealth Advocates Network
Fort Myers, FL1 day ago- A healthcare management organization is seeking experienced Physician Reviewers to join their Medicare Utilization Management team in a remote position. Responsibilities include reviewing clinical service requests, applying evidence-based guidelines, and collaborating...SuggestedRemote work
Solving IT
United States4 days ago - Kelsey-Seybold Clinic, part of the Optum family, is hiring a Utilization Review LVN nurse in Houston area. The role involves data entry, eligibility verification, and coordinating with insurers for pre-certification. Requirements include TX LVN license and UR experience...SuggestedRemote jobHourly pay
- Kelsey-Seybold Clinic, part of the Optum family, seeks a Utilization Review LVN to review medical necessity and benefit correlations for UR requests. The role facilitates communication with clinics, payors, and customers, ensuring timely pre-certifications and accurate...Suggested
- ...week. At Bradford Health Services, we don't just invest in our patients-we invest in our people. About the Role: The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient...SuggestedPart time
ADDICTION AND MENTAL
Lucedale, MS1 day ago - ...week. At Bradford Health Services, we don't just invest in our patients-we invest in our people. About the Role: The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient...SuggestedPart timeRemote work
ADDICTION AND MENTAL
United States1 day ago - A national healthcare staffing firm is seeking an experienced Registered Nurse for a position focused on Utilization Review. This role involves collaborating to enhance care continuity and conducting reviews for Medicaid and Medicare patients. The ideal candidate will...Suggested
$68.28k - $110.27k
...admitting teams concerning patient status determinations and utilization of hospital resources facilitating quality, cost-effective patient... ...appropriate status determinations through the utilization review process supporting quality, cost-effective patient outcomes. Responsible...SuggestedFull timeLocal area- Integra Partners, a national DMEPOS network administrator, seeks a remote Utilization Review Medical Director. You will conduct clinical reviews of DMEPOS requests, ensure determinations meet Medicare/Medicaid guidelines, and maintain high-quality documentation in a fast...Remote jobFull time
- HonorHealth in Arizona seeks an Utilization Review RN Specialist to review and monitor utilization for cost-effective, high-quality care. This role ensures medical necessity across Medicare, AHCCCS, and other payers, both on admission and concurrently. The position requires...Remote job
- ...seeking a Pharmacy Coordinator – Fraud, Waste, and Abuse (FWA) to support the Medical Management/Health Services team remotely. You will review FWA referrals, assist with regulatory requests, and help analyze and document investigations. The role requires 3+ years of...Remote work
Centene Corporation
Florida, NY1 day ago $40.12 - $62.19 per hour
Utilization Review Nurse RN - Grace Medical Center Baltimore, MD GRACE MEDICAL CENTER Part-time - Weekends - Day shift - 8:00am-4:30pm RN OTHER 96385 $40.12-$62.19 Experience based Posted:April 28, 2026 Apply Now Save Job Saved Summary JOB...Part timeShift workWeekend workDay shift- ...Utilization Review SpecialistThe Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient, and compliant with regulatory standards. This position involves thorough evaluation of patient...
Bradford Health Services
Jacksonville, FL4 days ago - Join Optum/UnitedHealth Group to support behavioral health and substance abuse case management through utilization reviews and care coordination. While not a member facing role, you'll help ensure they receive the right level of care at the right time. This is a fully remote...Remote workMonday to Friday
Optum
Tucson, AZ17 hours ago - ...retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy,... ...in acute clinical care Experience with medical record review/utilization review/utilization management Additional Information Are you...Contract workPrivate practiceMonday to Friday
HealthCare Support
Mason, OH1 day ago $20 - $30 per hour
...the behavioral health industry by delivering exceptional care, utilizing state-of-the-art facilities, and prioritizing the well-being of... ...: Exempt Travel Requirement: None Responsibilities Utilization Review on Behalf of the Clinics: Prescreen referrals to project/anticipate...Remote workGuidelight Health
New York, NY4 days ago$30 - $34 per hour
A healthcare services company is seeking an experienced Utilization Review Nurse to work remotely. The ideal candidate must hold an active LVN license in California and have experience in outpatient utilization management. Responsibilities include approving or denying...Hourly payRemote workAstrana Health
California, MO3 days ago- Centene Corporation is seeking a Behavioral Health Reviewer to assess and authorize mental health and substance abuse care across the care continuum. The role involves evaluating treatment, conducting prior authorizations, monitoring BH inpatient reviews, and collaborating...Remote job
- Centene Corporation is seeking a clinical reviewer to assess mental health and substance use care, including prior authorization and concurrent BH reviews. The role ensures the level of care is medically appropriate and coordinates with providers and families. This remote...Remote jobWork from homeWeekday work
- Centene Management Company LLC is seeking a remote Behavioral Health Reviewer to assess mental health and substance use care from home within the Central Time Zone. You will review level of care, perform prior authorizations, and help plan discharges while coordinating...Remote job
- ...Behavioral Health Utilization Management Coordinator This position is responsible for coordinating, integrating, and monitoring the... ...entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case Management to address member...Contract workWork at office
- Centene in the United States seeks a Behavioral Health Review clinician to assess mental health and substance use care, determine level of care, and authorize services. The role requires a nursing or master’s qualified clinician, U.S. licensure (RN, LCSW, LMHC, LPC, LMFT...Afternoon shift
- ...assess care related to mental health and substance abuse. This role involves evaluating treatment needs, performing authorization reviews, and improving service quality. Ideal candidates should have strong behavior health experience and a relevant license. This position...Remote jobFlexible hours
