Utilization Review Clinician
3 weeks 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.**Must be licensed in either of the following states: TX, KS, WA, OK, LA****Behavioral experience required****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 requiredPay Range: $25.97 - $46.68 per hourCentene 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.Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
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Utilization Review Clinician
4 weeks ago
Olympia, 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 Purpose: Performs a clinical review and assesses care related to mental...
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RN - Utilization Review
5 hours ago
Olympia, United States Providence Full timeRN - Utilization Review at Providence summary: The RN - Utilization Review is responsible for assessing the medical necessity and appropriate admission status of patients as part of the Utilization Management program. This role involves conducting comprehensive reviews, ensuring compliance with federal regulations, and collaborating across departments to...
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RN - Utilization Review
2 hours ago
Olympia, United States Providence Careers Full timeRN - Utilization Review at Providence Careers summary: The RN - Utilization Review nurse combines clinical expertise with management skills to assess patient admission status and ensure compliance with regulatory and reimbursement requirements. This role involves conducting comprehensive reviews and engaging in process improvement initiatives across...
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Utilization Review Manager
2 days ago
Olympia, Washington, United States Providence Full timeJob Overview:The Utilization Review Supervisor is responsible for supervising and coordinating the activities of the utilization management team to ensure that patients receive the most appropriate level of care. This includes assessing patient needs, developing care plans, and ensuring that patients receive timely access to necessary services.Key...
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RN - Utilization Review
4 days ago
Olympia, United States Providence Full timeDescription The Utilization Review (UR) Nurse has a strong clinical background blended with 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 effective, efficient processes for determining the appropriate admission...
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RN - Utilization Review
3 days ago
Olympia, United States Providence Full timeDescription The Utilization Review (UR) Nurse has a strong clinical background blended with 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 effective, efficient processes for determining the appropriate admission...
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Utilization Review Nurse Specialist
4 hours ago
Olympia, Washington, United States Providence Careers Full timeJob SummaryThe RN - Utilization Review nurse combines clinical expertise with management skills to assess patient admission status and ensure compliance with regulatory and reimbursement requirements. Key Responsibilities:• Conduct comprehensive reviews and engage in process improvement initiatives across departments• Track data related to utilization...
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RN - Utilization Review
2 days ago
Olympia, United States Providence Full timeDescription The Utilization Review (UR) Nurse has a strong clinical background blended with 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 effective, efficient processes for determining the appropriate admission...
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RN - Utilization Review
3 days ago
Olympia, United States Providence Full timeDescription The Utilization Review (UR) Nurse has a strong clinical background blended with 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 effective, efficient processes for determining the appropriate...
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RN - Utilization Review
3 days ago
Olympia, United States Providence Full timeDescription The Utilization Review (UR) Nurse has a strong clinical background blended with 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 effective, efficient processes for determining the appropriate...
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RN - Utilization Review
2 days ago
Olympia, United States Providence Full timeDescriptionThe Utilization Review (UR) Nurse has a strong clinical background blended with 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 effective, efficient processes for determining the appropriate admission status...
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Utilization Review Specialist
2 days ago
Olympia, Washington, United States Providence Full timeResponsibilitiesDevelop and maintain effective processes for determining patient admission status based on regulatory and reimbursement requirements.Collaborate with healthcare teams to ensure seamless patient transitions and minimize unnecessary hospitalizations.Utilize clinical expertise to review patient charts and provide recommendations for...
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RN - Utilization Review *DAYS*
2 weeks ago
Olympia, United States Providence Full timeRN - Utilization Review *DAYS* at Providence summary: The Utilization Review Nurse plays a critical role in determining patient admission statuses and ensuring compliance with regulatory and reimbursement requirements. This position requires a blend of clinical expertise and knowledge in Utilization Management, where the nurse conducts comprehensive reviews...
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RN - Utilization Review
3 days ago
Olympia, United States Providence Full timeDescription The Utilization Review (UR) Nurse has a strong clinical background blended with 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 effective, efficient processes for determining the appropriate...
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RN - Utilization Review
2 days ago
Olympia, United States Providence Full timeDescription The Utilization Review (UR) Nurse has a strong clinical background blended with 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 effective, efficient processes for determining the appropriate...
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RN - Utilization Review *DAYS*
2 weeks ago
Olympia, United States Providence Full timeRN - Utilization Review *DAYS* at Providence summary: The RN - Utilization Review nurse plays a vital role in managing and overseeing patient admission processes, ensuring compliance with medical necessity and governmental regulations. This position requires extensive knowledge in utilization management and collaboration with various departments to enhance...
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Registered Nurse
3 weeks ago
Olympia, United States Incredible Health Full timeHospitals on Incredible Health are actively hiring and accepting applications in the Olympia, WA area for the following position: Registered Nurse - Utilization Review. Nurses with experience in any of the following areas are strongly encouraged to apply: Clinical pathway, Navigator, or Utilization Review. Shift(s) available: day shift, night shift, and mid...
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RN - Utilization Review
4 days ago
Olympia, United States PROVIDENCE ST JOHNS HEALTH CENTER Full time $41 - $85DescriptionReqID: 332034Job Category: Health Information ManagementShift: DaySchedule: Per-DiemThe Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and...
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RN - Utilization Review
3 days ago
Olympia, United States PROVIDENCE ST JOHNS HEALTH CENTER Full time $41 - $85DescriptionReqID: 332034Job Category: Health Information ManagementShift: DaySchedule: Per-DiemThe Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and...
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Registered Nurse
2 weeks ago
Olympia, United States Incredible Health Full timeHospitals on Incredible Health are actively hiring and accepting applications in the Olympia, WA area for the following position: Registered Nurse - Utilization Review. Nurses with experience in any of the following areas are strongly encouraged to apply: Clinical pathway, Navigator, or Utilization Review. Shift(s) available: day shift, night shift, and...
