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$27.02 - $48.55 per hour
...Position Purpose Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines... ...planning Analyzes BH member data to improve quality and appropriate utilization of services Provides education to providers members and their...SuggestedHourly payFull timePart timeWork at officeRemote workFlexible hoursCentene Management Company LLC
Louisiana, MO1 day ago- ...Centene Corporation is seeking a Behavioral Health Utilization Review clinician to evaluate and authorize BH services, ensure appropriate levels of care, and collaborate with providers and medical leadership. This role emphasizes quality improvement, case presentations...SuggestedRemote work
Centene Corporation
Louisiana, MO2 days ago - ...Centene is seeking an Inpatient Utilization Review Clinician for Behavioral Health to perform clinical reviews and assessments ensuring appropriate care for members. This role emphasizes behavioral health utilization review with emphasis on the coordination of care across...SuggestedRemote workWeekend work
IntelliResume
Louisiana, MO3 days ago - ...Centene Management Company LLC is seeking a clinical reviewer for behavioral health with an active North Carolina license. The role... ...appropriateness across the care continuum. The ideal candidate has BH utilization review experience, strong communication skills, and the...SuggestedRemote work
Centene Management Company LLC
United States2 days ago - Centene Corporation seeks a clinical reviewer to assess care for mental health and substance use, ensuring level of care and medical... ...position supports provider education, care coordination, and utilization review within a collaborative team. #J-18808-Ljbffr Centene CorporationSuggested
- ...Management Company LLC is seeking a qualified professional to review member care and health status related to ABA services. The role... ...prior authorization for BH, analysis of data to improve utilization, and coordination with providers to ensure medically appropriate...SuggestedRemote job
$27.02 - $48.55 per hour
Position Purpose Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine... ...Analyzes BH member data to improve quality and appropriate utilization of services Interacts with BH healthcare providers as...SuggestedHourly payFull timePart timeWork at officeRemote workFlexible hours- Centene Corporation is seeking a clinical reviewer to assess mental health and substance use care, determine medical necessity, and support appropriate utilization. Remote work within the Central Time Zone is available with a Monday-Friday 8am-5pm schedule and occasional...SuggestedRemote jobMonday to Friday
- Centene Corporation is seeking a licensed clinician to review ABA services and health status across the care continuum, ensuring medical... ...prior authorization reviews, data analysis to improve utilization, and collaboration with BH providers. Time-zone residency in PST...SuggestedRemote workFlexible hours
- Centene Corporation is seeking a Remote Utilization Review RN to perform concurrent reviews and ensure medically necessary care for members. The role requires a CA RN license and acute care experience, with a Monday-Friday schedule and occasional weekend/holiday rotation...SuggestedRemote jobMonday to Friday
- Centene is seeking a remote Utilization Review Clinician - Behavioral Health based in North Carolina. You will evaluate treatment plans, perform prior authorizations, and conduct concurrent reviews for mental health and substance use services. Ideal candidates hold a master...SuggestedRemote jobFlexible hours
- Centene is seeking an Utilization Review Clinician - Behavioral Health to perform clinical reviews and assessments related to mental health and substance use, ensuring care levels are appropriate and medically necessary. Based in Louisiana, this remote, full-time role...SuggestedRemote jobFull timeDay shift
- ...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 - ...professionals Assist physicians and hospital staff with resource utilization and timely discharge planning Coordinate services between... ...departments to facilitate patient discharge Conduct concurrent reviews of patient records Apply utilization criteria to determine appropriate...SuggestedWork at office
Jobtailor
Oklahoma City, OK2 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
$26 - $28 per hour
...Location: On-Site inLong Beach, CA Schedule: 8-hour shiftsThursday-Monday Pay Range: $26.00-28.00 hourly PositionSummary The Utilization Review (UR) Coordinator provides administrative support to ensure compliance with HMO, Medicare, and Medi-Cal insurance requirements...Hourly payLocal areaOcean view psychiatric hospital
Long Beach, CA1 day ago- ** OUTSTANDING OPPORTUNITY - CLINICAL NAVIGATOR - SR. UTILIZATION REVIEW NURSE II ** ** POPULATION HEALTH WORK EXPERIENCE A SIGNIFICANT PLUS! ** The Clinical Navigator - Senior Utilization Review Nurse II serves at the intersection of quality improvement, population...Temporary workWork experience placementLocal area
- ...To support Utilization Management operations, the full-time Utilization Review Medical Director will conduct clinical reviews of Durable Medical Equipment (DME) requests remotely, ensuring compliance with Medicare and Medicaid guidelines while maintaining productivity...Full timeRemote work
Virtual Vocations Inc
United States1 day ago - Kaiser Permanente is seeking a Clinical Reviewer to adjudicate coverage requests using established criteria and contract language. You... ...or family medicine, Washington license, and experience in utilization/quality management. Strong collaboration and communication are...Contract work
- ...Permanente Medical Group, a KP health plan partner, seeks a Clinical Reviewer to adjudicate coverage requests using established criteria.... .../DO with internal or family medicine residency; experience in utilization management and quality programs is preferred. #J-18808-Ljbffr...
- Optum is seeking an Utilization Management Nurse to review patient records and craft defensible appeal letters. The role requires an RN license, 3+ years bedside experience, and strong data extraction skills. You will work per diem with flexible start times and may telecommute...Remote jobDaily paidWork at officeFlexible hours
$2,139 per week
...Registered Nurse (RN) | Utilization Review Location: Somerville, MA Agency: Magnet Medical Pay: $2,139 per week Shift Information: Days - 5 days x 8 hours Contract Duration: 11 Weeks Start Date: 10/15/2026 About the Position The Registered...Full timeContract workShift workMagnet Medical
Somerville, MA1 day ago- 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
- ...poised for future growth. About this position: Work Monday - Friday, the core business hours are 8:00 AM - 5:00 PM As a Utilization Review Registered Nurse for Johns Hopkins Health Plans, you have the opportunity to use your clinical, managed care, utilization...Full timeRemote workMonday to Friday
Johns Hopkins Medicine
Hopkins, MN17 days 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...
- ...Utilization Review Specialist The 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...
Bradford Health Services
Knoxville, TN4 days 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...Part time
ADDICTION AND MENTAL
Southaven, MS2 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, AZ4 days 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, OH2 days ago
