Utilization Review Clinician

1 month ago

Sacramento, United States Centene Corporation Full time

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 reside within the state of California.** **Position Purpose:** Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. + Evaluates member's care and health status before, during, and after provision of Applied Behavioral Analysis (ABA) services to ensure level of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards + Performs prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and criteria + Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services + Provides education to members and their families regrading ABA and BH utilization process + Provides feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies + 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. Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services 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 + Board Certified Behavior Analyst (BCBA) preferred Pay Range: $25.97 - $46.68 per hour 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. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

  • Experienced Core Coordinator RN for Utilization Review

    4 days ago

    Sacramento, California, United States Medical Solutions Full time

    Job OverviewWe are seeking a seasoned Registered Nurse to join our team as a Core Coordinator in Utilization Review.About the RoleThis is a 13-week contract opportunity with 40 hours per week, working 8-hour shifts.The ideal candidate will have at least 3 years of hospital experience and be proficient in Midas, InterCall, Cerner, Curaspan, and Microsoft...

  • Travel Nurse RN

    2 days ago

    Sacramento, United States Medical Solutions Full time

    Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Sacramento, California.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Travel We’re seeking talented healthcare professionals whose adventure game is as...

  • Travel Nurse RN

    5 days ago

    Sacramento, United States Medical Solutions Full time

    Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Sacramento, California.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Travel We’re seeking talented healthcare professionals whose...

  • Travel Nurse RN

    5 days ago

    Sacramento, United States Medical Solutions Full time

    Job DescriptionMedical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Sacramento, California.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelWe’re seeking talented healthcare professionals whose...

  • Travel Nurse RN

    5 days ago

    Sacramento, United States Medical Solutions Remote Work Freelance Full time

    Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Sacramento, California.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Travel We’re seeking talented healthcare professionals whose...

  • Travel Nurse RN

    5 days ago

    Sacramento, United States Medical Solutions Remote Work Freelance Full time

    Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Sacramento, California.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Travel We’re seeking talented healthcare professionals whose...

  • Travel Nurse RN

    4 days ago

    Sacramento, United States Medical Solutions Full time

    Job DescriptionMedical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Sacramento, California.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Travel We’re seeking talented healthcare professionals whose...

  • Medical Solutions | Travel Nurse RN

    4 days ago

    sacramento, United States Medical Solutions Full time

    Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Sacramento, California.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Travel We’re seeking talented healthcare professionals whose...

  • Travel Nurse RN

    5 days ago

    Sacramento, CA, United States Medical Solutions Full time

    Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Sacramento, California. Job Description & Requirements Specialty: Utilization Review Discipline: RN Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel We’re seeking talented healthcare professionals whose...

  • Travel Nurse RN

    5 days ago

    Sacramento, CA, United States Medical Solutions Full time

    Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Sacramento, California. Job Description & Requirements Specialty: Utilization Review Discipline: RN Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel We’re seeking talented healthcare professionals whose...

  • RN Clinical Review Nurse

    1 month ago

    Sacramento, United States Centene Corporation Full time

    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. Fully Remote Position that requires California RN Licensure. **Position...

  • Medical Solutions | Travel Nurse RN

    4 days ago

    Sacramento, CA, United States Medical Solutions Full time

    Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Sacramento, California. Job Description & Requirements Specialty: Utilization Review Discipline: RN Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel We’re seeking talented healthcare professionals whose...

  • Travel Nurse RN

    5 days ago

    Sacramento, CA, United States Medical Solutions Full time

    Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Sacramento, California.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Travel We’re seeking talented healthcare professionals whose...

  • Healthcare Review Specialist

    4 weeks ago

    Sacramento, California, United States State of California Full time

    Working for the State of California as a Nurse Evaluator II offers an exciting opportunity to contribute to the delivery of quality healthcare to millions of Californians. As a key member of the Contract and Enrollment Review Division, Audits and Investigations team, you will play a vital role in supporting the integrity of health programs administered by...

  • Crisis Response Clinician

    4 weeks ago

    Sacramento, California, United States WellSpace Health Full time

    Job OverviewWe are seeking a skilled Crisis Response Clinician to join our team at WellSpace Health.This is a unique opportunity to make a meaningful difference in the lives of individuals and families in crisis. As a Crisis Response Clinician, you will be responsible for providing critical support and guidance to those in need, utilizing your exceptional...

  • Mental Health Clinician

    2 weeks ago

    Sacramento, United States El Hogar Community S Full time

    Job DescriptionJob DescriptionSummary:  The Mental Health Clinician is responsible for delivering mental health, substance abuse, and support services consistent with the principles of the Psychosocial Rehabilitation and Strengths-Based Models to an adult population who struggle with mental illness.  The Mental Health Clinician provides Behavioral Health...

  • Crisis Clinician

    2 weeks ago

    Sacramento, United States Children's Receiving Home Full time

    Job DetailsLevel Experienced Job Location Childrens Receiving Home - Sacramento, CA Position Type Full Time Education Level Graduate Degree Salary Range $66,560.00 Salary/year Travel Percentage Negligible Job Shift Day Job Category Nonprofit - Social Services Description2 Full-Time, Salaried, Exempt Positions AvailablePosition Summary: The Crisis Clinician...

  • Emergency Mental Health Clinician

    3 weeks ago

    Sacramento, California, United States WellSpace Health Full time

    Career OpportunitiesWe are looking for a dedicated and experienced Emergency Mental Health Clinician to join our team at WellSpace Health. In this role, you will provide crisis intervention and behavioral health triage via telephone or telehealth as needed. You will also adhere to national standards in assessing suicide risk and developing actionable safety...

  • Clinical Review Nurse

    1 month ago

    Sacramento, United States Centene Corporation Full time

    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:** Analyzes all prior authorization requests to determine...

  • Financial Statement Reviewer Position

    7 days ago

    Sacramento, California, United States Crowe Full time

    Your Opportunity to Grow with UsAudit Staff Fall 2025Crowe is seeking a highly motivated and detail-oriented individual to join our Audit team as an Audit Staff member. In this role, you will be responsible for performing various tasks related to financial statement audits, reviews, and compilations. This includes assisting in the preparation of financial...