We have other current jobs related to this field that you can find below
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Utilization Review Specialist
7 days ago
Lake Worth, United States Praesum Healthcare Full timeJob DescriptionJob DescriptionPraesum Healthcare: Position Title: Utilization Review Specialist Founded in 2003, Praesum Healthcare provides administrative services for healthcare providers in key geographical locations throughout the Northeast, mid-Atlantic, and Southeast regions. Praesum is an established leader in the healthcare industry. With a solid,...
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Utilization Review Specialist
3 weeks ago
Lake Worth, United States Praesum Healthcare Full timeJob DescriptionJob DescriptionPraesum Healthcare: Position Title: Utilization Review Specialist Founded in 2003, Praesum Healthcare provides administrative services for healthcare providers in key geographical locations throughout the Northeast, mid-Atlantic, and Southeast regions. Praesum is an established leader in the healthcare industry. With a solid,...
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Clinical Utilization Review Analyst
5 days ago
Lake Worth, Florida, United States Praesum Healthcare Full timeJob OverviewPosition Title: Clinical Utilization Review AnalystPraesum Healthcare, established in 2003, specializes in providing administrative support for healthcare providers across key regions in the Northeast, mid-Atlantic, and Southeast. As a recognized leader in the healthcare sector, Praesum is committed to growth and excellence.Our organization...
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Utilities Development Review Specialist
2 months ago
Salt Lake City, United States Salt Lake City Full timePosition Title:Utilities Development Review SpecialistJob Description:Reporting to Utilities Development Review Coordinator, incumbent assists with the development, recording and maintaining of all developer-initiated water, sanitary sewer and storm drainage extension and service connection agreements; assists with the management of all related construction...
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Utilization Management Clinician
2 weeks ago
Salt Lake City, United States CVS Pharmacy Full timeFully remote in the USA. Monday- Friday 12 pm-8:30 pm EST. No holidays and no weekends. - Utilizes clinical experience, and skills, in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based st Behavioral Health, Clinician, Behavioral, Management, Health, Clinical, Retail
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Registered Nurse
4 days ago
Salt Lake, Utah, United States Cross Country Nurses Full timeCross Country Nurses is currently seeking a dedicated Registered Nurse (RN) specializing in Utilization Review for a travel nursing opportunity. Position Overview As a Registered Nurse, your primary responsibility will be to deliver exceptional care to patients experiencing health challenges. Your role may involve working in various settings such as...
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Clinician
3 months ago
Lake Worth, United States USCRI Full timeJob DescriptionJob DescriptionU.S. Committee for Refugees and Immigrants (USCRI), is a non-governmental, not-for-profit international organization with a mission to protect the rights and address the needs of persons in migration by advancing fair and humane public policy, facilitating and providing direct professional services, and promoting the full...
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Clinician
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Lake Worth Beach, United States US COMM FOR REFUGE Full timeU.S. Committee for Refugees and Immigrants (USCRI), is a non-governmental, not-for-profit international organization with a mission to protect the rights and address the needs of persons in migration by advancing fair and humane public policy, facilitating and providing direct professional services, and promoting the full participation of migrants in...
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Travel Nurse RN
1 month ago
Salt Lake City, United States Cross Country Nurses Remote Work Freelance Full timeCross Country Nurses is seeking a travel nurse RN Utilization Review for a travel nursing job in Salt Lake City, Utah.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNStart Date: 08/26/2024Duration: 17 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelJob DescriptionAs a registered nurse (RN), you will provide care for...
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Travel Nurse RN
4 weeks ago
salt lake city, United States Cross Country Nurses Full timeCross Country Nurses is seeking a travel nurse RN Utilization Review for a travel nursing job in Salt Lake City, Utah.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNStart Date: 08/26/2024Duration: 17 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelJob DescriptionAs a registered nurse (RN), you will provide care for...
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Salt Lake City, United States CVS Pharmacy Full timeFully remote in the USA. Schedule: Saturday and Sunday 9 am-7 pm MT - Monday and Tues 3 p-1 am MT - Must be able to work Holidays. There will be a 12.5% differential for this shift. Utilizes clinical skills to coordinate, document and communicate all Behavioral Health, Night Shift, Clinician, Behavioral, Management, Night, Retail, Healthcare
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Travel Nurse RN
4 weeks ago
Salt Lake City, UT, United States Cross Country Nurses Full timeCross Country Nurses is seeking a travel nurse RN Utilization Review for a travel nursing job in Salt Lake City, Utah. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 08/26/2024 Duration: 17 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Job Description As a registered nurse (RN), you...
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Travel Nurse RN
4 weeks ago
Salt Lake City, UT, United States Cross Country Nurses Full timeCross Country Nurses is seeking a travel nurse RN Utilization Review for a travel nursing job in Salt Lake City, Utah. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 08/26/2024 Duration: 17 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Job Description As a registered nurse (RN), you...
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Travel Nurse RN
2 months ago
Salt Lake City, UT, United States Cross Country Nurses Full timeCross Country Nurses is seeking a travel nurse RN Utilization Review for a travel nursing job in Salt Lake City, Utah.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNStart Date: 07/15/2024Duration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelJob DescriptionAs a registered nurse (RN), you will provide care for...
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EMDR Clinician
1 day ago
Palmer Lake, United States Advanced Recovery Systems Full timeOverview:Join our team and build your career helping others rebuild their lives!Are you a passionate Licensed Clinician looking to utilize your skillset by making an impact in the lives of others?We’ve got an opportunity for you at our Recovery Village at Palmer Lake!Licensed EMDR ClinicianPay Ranges: $32 - $41 per hourSchedule: Sunday - Thursday, 8am -...
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Consulting Utility Forester/ Utility Arborist
3 weeks ago
Lake City, United States Atlas Field Services Full timeJob DescriptionJob DescriptionAtlas Field Services is scouting for Consulting Utility Foresters/ Utility Arborists to join our team as full-time employees. We are looking to fill this role in the following areas: Lake City, FL Who are we? We’re dedicated to the growth of our employees. We truly believe in your development. For those who show initiative,...
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Consulting Utility Forester/ Utility Arborist
4 weeks ago
Lake City, United States Atlas Field Services Full timeJob DescriptionJob DescriptionAtlas Field Services is scouting for Consulting Utility Foresters/ Utility Arborists to join our team as full-time employees. We are looking to fill this role in the following areas: Lake City, FL Who are we? We’re dedicated to the growth of our employees. We truly believe in your development. For those who show initiative,...
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Salt Lake City, United States CVS Pharmacy Full timeFully remote in the USA.1st req Schedule: Saturday and Sunday 10 am-8 pm MT - Thu and Friday 3 p-1 am MT - Must be able to work Holidays. There will be a 12.5% differential for this shift . nd req Schedule: Saturday and Sunday 8 am-6 pm MT - Monday a Behavioral Health, Night Shift, Clinician, Behavioral, Management, Night, Retail, Healthcare
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EMDR Clinician
1 day ago
Palmer Lake, CO, United States Advanced Recovery Systems Full timeOverview:Join our team and build your career helping others rebuild their lives!Are you a passionate Licensed Clinician looking to utilize your skillset by making an impact in the lives of others?We’ve got an opportunity for you at our Recovery Village at Palmer Lake!Licensed EMDR ClinicianPay Ranges: $32 - $41 per hourSchedule: Sunday - Thursday, 8am -...
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Lead Clinician
3 days ago
Palmer Lake, United States Advanced Recovery Systems Full timeOverview:Join our team and build your career helping others rebuild their lives!Are you a passionate Licensed Clinician looking to utilize your skillset by making an impact in the lives of others?We’ve got an opportunity for you at our Recovery Village at Palmer Lake!Licensed Lead ClinicianPay Ranges: up to $42 per hour, (Annualized up to $87,360)Schedule:...
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Utilization Review Clinician
2 months ago
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
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 appropriate.
(Must hold either a KS or a WA license in the BH arena).
- Evaluates member's treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate
- Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria
- Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning
- Analyzes BH member data to improve quality and appropriate utilization of services
- Provides education to providers members and their families regrading BH utilization process
- Interacts with BH healthcare providers as appropriate to discuss level of care and/or services
- Engages with medical directors and leadership to improve the quality and efficiency of care
- Formulates and presents cases in staffing and integrated rounds
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 - 4 years of related experience.
License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.
Master's degree for behavioral health clinicians required.
Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred.
Knowledge of mental health and substance abuse utilization review process preferred.
Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred.
License/Certification:
- LCSW- License Clinical Social Worker required or
- LMHC-Licensed Mental Health Counselor required or
- LPC-Licensed Professional Counselor required or
- Licensed Marital and Family Therapist (LMFT) required or
- Licensed Mental Health Professional (LMHP) required or
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.