We have other current jobs related to this field that you can find below
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Utilization Review Clinician
1 month ago
Stillwater, United States Centene Corporation Full timeYou 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 is REMOTE but candidate must reside in STATE of OKLAHOMA Position...
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Utilization Review Clinician
2 months ago
Lawton, OK, United States Centene Full timeYou 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 is REMOTE but candidate must reside in STATE of OKLAHOMA***Position...
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Utilization Review Clinician
4 weeks ago
Hialeah, FL, United States Centene Full timeYou 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. THERE ARE 3 POSITIONS AVAILABLE/BUILDING A NEW PROGRAM.THESE POSITIONS ARE...
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RN-Utilization Review
3 weeks ago
Austin, TX, United States Ascension Seton Northwest Full timeRN-Utilization ReviewDetails * Department: UR Review * Schedule: FT - Days * Location: Austin, TX - Remote after 4 weeks of training onsite Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental...
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Leesburg, FL, United States UF Health-Central Florida Full timeOverview UF Health Leesburg Hospital has been serving the health care needs of our community for 58 years. The hospital offers advanced cardiac care including one of the largest cardiothoracic surgery programs in the state. The American College of Cardiology has recognized UF Health Leesburg Hospital for its demonstrated expertise and commitment in treating...
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LPN for Utilization Review
2 days ago
Fontana, CA, United States Pyramid Consulting Full timePyramid Consulting is currently looking for a dedicated Licensed Practical Nurse (LPN) to fill a Utilization Review role on a local contract basis.Position OverviewThe selected candidate will be responsible for:Specialty: Utilization ReviewDiscipline: LPNEmployment Type: Local ContractKey ResponsibilitiesThe LPN will engage in:Coordinating...
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Utilization Review
1 month ago
Jacksonville, FL, United States Saint Vincent's Medical Center Riverside Full timeUtilization Review - Registered Nurse - RNDetails * Department: Utilization Review * Schedule: Varied - PRN * Hospital: Ascension St. Vincent's Riverside Hospital * Location: Jacksonville, FL Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term...
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Utilization Review Nurse
2 days ago
Bremen, IN, United States Neuropsychiatric Hospitals Full timeAbout Us:HEALING THE BODY AND MINDFounded fifteen (15) years ago, NeuroPsychiatric Hospital is the largest hospital system in the nation providing care to patients with both neurological and medical needs. We are unique in that we serve a population which others have been previously been unable to, largely due the patient’s underlying medial issues. Our...
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Utilization Review RN
4 days ago
Austin, TX, United States Ascension Full timeDetails Department: Utilization ReviewSchedule: Full-time, 8-hour day shift, Monday-Friday, Remote, including occasional on-site needs, weekends and holidays requiredFacility: Ascension Care Management InsuranceBenefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term &...
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Utilization Review RN
2 months ago
Fredericksburg, VA, United States Mary Washington Healthcare Full timeStart the day excited to make a difference…end the day knowing you did. Come join our team.Job Summary:The Utilization Review Nurse is responsible for following the healthcare system’s Utilization Program which integrates the function of utilization review and resource management to assure care is provided in the most appropriate setting utilizing...
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Utilization Review RN
2 weeks ago
Seattle, WA, United States Swedish Health Services Full timeDescription Remote - Utilization Review RN On call/Per diem The Utilization Review (UR) Nurse has a strong clinical background blended with a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining...
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Physician Review/Utilization Review Physician
1 month ago
San Diego, CA, United States Vivo HealthStaff Full timeVivo HealthStaff is searching for a Physician for a health plan based in San Diego, CA. This is a full-time position with competitive benefits. The Physician Reviewer will perform all reasonably necessary functions to ensure the quality of care and appropriate utilization in the most cost-effective, appropriate, and professional manner, which meets the...
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Utilization Review Coordinator
2 days ago
Phoenix, AZ, United States Neuropsychiatric Hospitals Full timeAbout Us:HEALING THE BODY AND MINDFounded fifteen (15) years ago, NeuroPsychiatric Hospital is the largest hospital system in the nation providing care to patients with both neurological and medical needs. We are unique in that we serve a population which others have been previously been unable to, largely due the patient’s underlying medial issues. Our...
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Utilization Review RN
3 weeks ago
Everett, WA, United States Providence Full timeDescription Oversee utilization management and review of patients care delivery while in the hospital and provide clinical reviews and denial appeals where appropriate either during admission or post discharge. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Regional Medical Center Everett...
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Utilization Review RN
1 month ago
Everett, WA, United States Providence Full timeDescription Oversee utilization management and review of patients care delivery while in the hospital and provide clinical reviews and denial appeals where appropriate either during admission or post discharge. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Regional Medical Center Everett...
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Utilization Review RN
1 month ago
Everett, WA, United States Providence Full timeDescription Oversee utilization management and review of patients care delivery while in the hospital and provide clinical reviews and denial appeals where appropriate either during admission or post discharge. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Regional Medical Center Everett...
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Utilization Review RN
3 days ago
Everett, WA, United States Providence Full timeDescription Oversee utilization management and review of patients care delivery while in the hospital and provide clinical reviews and denial appeals where appropriate either during admission or post discharge. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Regional Medical Center Everett...
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RN-Utilization Review
3 weeks ago
Austin, TX, United States Ascension Full timeDetails Department: UR ReviewSchedule: FT - DaysLocation: Austin, TX - Remote after 4 weeks of training onsiteBenefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental leave & adoption assistance Tuition...
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Utilization Review Coordinator
2 days ago
Crown Point, IN, United States Neuropsychiatric Hospitals Full timeAbout Us:HEALING THE BODY AND MINDFounded fifteen (15) years ago, NeuroPsychiatric Hospital is the largest hospital system in the nation providing care to patients with both neurological and medical needs. We are unique in that we serve a population which others have been previously been unable to, largely due the patient’s underlying medial issues. Our...
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Registered Nurse
1 month ago
Overland Park, KS, United States Wellsky Full timeThe Utilization Review Nurse performs prospective and retrospective reviews for post-acute care services. The purpose and goal of utilization management is to assure that Wellsky’s population receives medically necessary services in the appropriate setting, with the appropriate provider, and at the appropriate level of care. This position is responsible...
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.
This is a remote position
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.
- 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.
