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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... ...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 Corporation
Louisiana, MO3 days ago- ...Centene Corp. is seeking an Utilization Review Clinician - Behavioral Health to conduct clinical reviews for mental health and substance use services, ensuring appropriate level of care for Oregon Medicaid in a fully remote role. The position follows a Monday–Friday...SuggestedRemote workMonday to Friday
Centene Corporation
United States4 days ago - ...Centene Corporation is seeking a fully remote Behavioral Health Utilization Review Specialist. The role focuses on evaluating mental health and substance use care, performing prior-authorizations, and conducting concurrent reviews to ensure medically appropriate levels...SuggestedRemote work
Centene Corporation
United States4 days ago - ...Centene is seeking an Utilization Review Clinician - Behavioral Health to perform clinical reviews and assess care for mental health and substance use. This remote role supports clinicians across the continuum of care while collaborating with providers to determine appropriate...SuggestedRemote work
IntelliResume
United States2 days ago - ...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...SuggestedFull timeRemote workDay shift
IntelliResume
United States2 days ago - ...Utilization Review Registered Nurse 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 physicians...SuggestedFull timeReliefWeekend workWeekday work
BayCare
Tampa, FL18 hours ago - ...Centene is seeking a remote Utilization Review Clinician - Behavioral Health to support Oregon Medicaid. The role requires independent clinical licensure and experience in behavioral health and utilization management. It offers a full-time day-shift schedule and a...SuggestedFull timeRemote workDay shift
Centene
Oregon State15 hours ago $27.02 - $48.55 per hour
...About This Role The Utilization Review Clinician - Behavioral Health performs clinical reviews and assessments related to mental health and substance abuse, ensuring that the level of care and services provided are medically appropriate. This fully remote role supports...SuggestedFull timeWork at officeRemote workFlexible hoursDay shiftCentene
Oregon State15 hours ago- 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
- ...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
- 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
- Centene is seeking a Clinical Review Nurse for a remote role supporting members in Pennsylvania. The candidate will perform concurrent... ...to discharge planning, leveraging case management or utilization management experience. The position offers day-shift, full-time...SuggestedRemote jobFull timeShift workDay shift
- Centene is hiring a Utilization Review Clinician - Behavioral Health for a fully remote position, serving members nationwide with a focus on mental health and substance abuse utilization management. The role emphasizes clinical reviews, prior authorizations, and data-driven...SuggestedRemote job
- Centene Corp. is seeking an Utilization Review Clinician to evaluate ABA services for medical appropriateness and oversee prior authorization reviews. The role requires strong behavioral health knowledge and collaboration with healthcare providers to ensure effective care...SuggestedRemote job
- Centene Corporation is seeking a remote Behavioral Health/Utilization Review professional to support the California Market. The role requires nursing or bachelor’s degree with 2-4 years of related experience and appropriate behavioral health licensure. The position offers...SuggestedRemote jobFull time
- ...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...Remote work
Medix
United States4 days ago - BayCare in Tampa, FL invites an experienced Utilization Review Senior RN for a PRN/hybrid role at St. Josephs. You will coordinate care with funding agents, perform concurrent reviews for medical necessity of outpatient observation and inpatient stays, and handle concurrent...Relief
- Centene Corporation is seeking a remote Behavioral Health Clinical Reviewer to support Oregon Medicaid. The role conducts clinical reviews... ...leadership to ensure appropriate levels of care and efficient utilization of services. Required qualifications include a nursing or...Remote job
$2,448 per week
...Registered Nurse (RN) | Utilization Review Location: Arcata, CA Agency: Unicorn Medical Solutions LLC Pay: $2,448 per week Shift Information: Days - 5 days x 8 hours Contract Duration: 13 Weeks Start Date: ASAP About the Role: TravelNurseSource...Full timeContract workImmediate startShift workTravelNurseSource
Arcata, CA16 hours ago- ...Humana Inc is seeking a Medical Director to lead inpatient medical necessity reviews and utilization management with a focus on quality and physician collaboration. The role leverages hospital medicine, critical care, or ED experience to assess complex cases and support...Remote work
Humana
United States1 day ago - Manager, Central Utilization Review- Full Time, Days, 8 AM - 4 PM, Morristown NJ Morristown, NJ, United States Job Description Lead AHS clinical denial prevention and management initiatives to support appropriate level of care. Works closely with AHS revenue cycle leaders...Full timeContract workLocal area
$60k - $70k
...Bradford is more than a healthcare network; we are recovery communities for every stage of the journey. We are seeking a Utilization Review Specialist to add to our dynamic team! The Utilization Review Specialist plays a critical role in ensuring that healthcare services...Full timePart timeWork at officeRemote workAddiction And Mental Health Services
Birmingham, AL4 days ago- HonorHealth in Phoenix is seeking an Utilization Review RN Specialist to review and monitor utilization, ensuring medically necessary care and appropriate discharge planning within Medicare, AHCCCS, Self-pay, and other payer guidelines. The ideal candidate has an RN license...Remote job
$80k - $90k
...transform healthcare delivery and make a meaningful difference in the lives of our members. SUMMARY: The Utilization Management Pre-Service (Outpatient) Review Nurse is responsible for managing inpatient & outpatient utilization by conducting thorough reviews of clinical...Full time$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...Full timeLocal area$52 - $56 per hour
...you'll apply the same medical necessity judgment you built in utilization management. 100% remote (U.S.) | Contract | $52-$56/hr based on... ...and appeals end to end: intake, investigation, clinical review, decision and notification Apply medical necessity criteria (InterQual...Remote jobContract workAfternoon shift- Utilization Review Nurse Auditor (33034)# Utilization Review Nurse Auditor (33034)Fully Remote • Mount Laurel, NJ 08054## OverviewSalary Range$33.00 - $46.00 HourlyPosition TypeFull TimeTravel Percentage10%## Description**ExamWorks is looking for a Utilization Review Nurse...Local areaRemote workMonday to Friday
- A healthcare revenue management company is seeking a Vice President of Utilization Review to oversee strategic direction and operational efficiency in Lauderdale Lakes, FL. This full-time role focuses on revenue cycle management, requiring strong leadership, strategic...Full time
- Optum is seeking a Behavioral Health Utilization Review Specialist to support case management and care coordination remotely. You will review cases, determine levels of care, and coordinate transitions between inpatient and outpatient settings. You will collaborate with...Remote jobMonday to Friday
- Centene Corporation in the United States is seeking a Nursing/Behavioral Health reviewer to assess ABA services for medical appropriateness across care episodes. You will monitor clinical effectiveness and work with BH providers to discuss level of care. Qualified candidates...Remote jobFlexible hours
