Utilization Review Clinician
3 days 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 is REMOTE 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 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.
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Utilization Review Clinician
5 days ago
Columbus, 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***** **Position Purpose:** Performs a clinical review...
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Utilization Review Specialist
3 weeks ago
Columbus, United States Springstone, Inc. Full timeOverview Columbus Springs East is a -bed behavioral hospital located near Columbus, OH. The hospital offers inpatient and outpatient mental health and addiction treatment to adults, adolescents and their families. At Columbus Springs we are dedicated to Changing People’s Lives® . The Utilization Review department plays an essential role in...
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Utilization Review Specialist
2 months ago
Columbus, United States Acadia Healthcare Inc. Full time* Act as liaison between managed care organizations and the facility professional clinical staff. * Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements. * Monitor patient length of stay and extensions and...
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Clinical Review/Utilization Nurse
4 weeks ago
Columbus, GA, United States Children's Healthcare of Atlanta Full timeNote: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Variable Work Day(s) Variable Shift Start Time 8:00 AM Shift End Time 4:00 PM Worker Sub-Type PRN Children’s is one of the nation’s leading children’s...
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Utilization Review
1 month ago
Columbus, United States MARYHAVEN,INC Full timeJob DescriptionJob DescriptionUtilization Review Specialist Job DescriptionUnique opportunity to join Maryhaven, Central Ohio’s largest and most comprehensive behavioral services provider specializing in addiction recovery. We are looking for skilled, talented, and compassionate people to join our team! Maryhaven was founded on the principles of Diversity,...
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Utilization Review
5 days ago
Columbus, United States MARYHAVEN,INC Full timeJob DescriptionJob DescriptionUtilization Review Specialist Job DescriptionUnique opportunity to join Maryhaven, Central Ohio’s largest and most comprehensive behavioral services provider specializing in addiction recovery. We are looking for skilled, talented, and compassionate people to join our team! Maryhaven was founded on the principles of Diversity,...
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Family Advocacy Clinician II
1 month ago
Columbus, United States Nationwide Children's Hospital Full timeOverview The Center for Family Safety and Healing - Adult Clinician provides assessment and treatment to adults who have experienced intimate partner violence. The clinician works within the context of a multidisciplinary team setting and is responsible for timely reporting, documentation, and participation in treatment and case plan development at the...
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Behavioral Health Clinician
4 days ago
Columbus, United States Lutheran Social Services of Central Ohio Full timeJob DescriptionJob DescriptionBehavioral Health Clinician Full Time | Day Shift | 8am - 5 pmLutheran Social Services of Central Ohio is currently seeking a Behavioral Health Clinician for LSS Health Center (formerly Health Center at Faith Mission) in Columbus, Ohio. LSS Health Center is here to provide quality, easily accessible, and comprehensive care to...
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Behavioral Health Clinician
2 days ago
Columbus, United States Lutheran Social Service Full timeBehavioral Health Clinician Full Time | Day Shift | 8am - 5 pmLutheran Social Services of Central Ohio is currently seeking a Behavioral Health Clinician for LSS Health Center (formerly Health Center at Faith Mission) in Columbus, Ohio. LSS Health Center is here to provide quality, easily accessible, and comprehensive care to all regardless of income or...
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Behavioral Health Clinician
4 days ago
Columbus, United States Lutheran Social Services of Central Ohio Full timeBehavioral Health Clinician Full Time | Day Shift | 8am - 5 pmLutheran Social Services of Central Ohio is currently seeking a Behavioral Health Clinician for LSS Health Center (formerly Health Center at Faith Mission) in Columbus, Ohio. LSS Health Center is here to provide quality, easily accessible, and comprehensive care to all regardless of income or...
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Bilingual Clinician- JOR
5 days ago
Columbus, United States Istituto Marangoni Full timeJob Details Job Location : Madison, WI Education Level : 4 Year Degree Salary Range : Undisclosed Job Category : Nonprofit - Social Services Working At NYAP NYAP's commitment to doing what isbestfor children, youth and their families is a core value and one that we look for in our newest team members. 22 Days Off Each Year! Plus 11 Paid Holidays Per...
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Utilization Management
2 weeks ago
Columbus, United States RiverVista Health and Wellness Full timeRole: UM DirectorJob Post Title: Utilization Review DirectorShift: M-FHours: 8-4:30 9-5The Role Itself Oversees service requests, authorizations and LOS metrics.Reviews documentation quality for clinical effectiveness in regards to reimbursement.Participates in clinical team for goal alignment and compliance.Manages patient transitions between LOC and...
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Utilization Management
4 weeks ago
Columbus, United States RiverVista Health and Wellness Full timeWho we areThe #NewVista mission is to inspire hope and deliver holistic care to those in need of behavioral health services in a contemporary and healing environment – one that is conducive to providing the life skills needed to regain stability and independence, utilizing a passionate and highly trained team of professionals. With a blend of group...
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Lead Group Clinician
3 months ago
Columbus, United States ST VINCENT FAMILY SERVICES Full timeJob DescriptionJob DescriptionSummaryThe Lead Group Clinician is responsible for facilitating daily group therapy in the Prep Academy Program and providing daily coordination of group curriculum and materials needed to facilitate group. Under direct supervision of the Prep Academy Clinical manager, this individual is also responsible for coordinating...
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Seasonal Application Reviewer
5 days ago
Columbus, United States InsideHigherEd Full timeScreen reader users may encounter difficulty with this site. For assistance with applying, please contact hr-accessibleapplication@osu.edu. If you have questions while submitting an application, please review these frequently asked questions.Current Employees and Students:If you are currently employed or enrolled as a student at The Ohio State University,...
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Utility
1 month ago
Columbus, United States BHI Energy Full timeUtility Columbus, OH Posted: 1/18/2024 Job Description Job ID#: 344698 Job Category: Utility Duration: 1 yr About BHI Energy BHI Energy is a broad umbrella organization with a complete service offering that covers all facets of Power Generation through the entire Electrical Delivery system. For over 40 years, our diverse services have been...
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Utility
3 weeks ago
Columbus, United States BHI Energy Full timeUtility Columbus, OH Posted: 1/18/2024 Job Description Job ID#: 344698 Job Category: Utility Duration: 1 yr About BHI Energy BHI Energy is a broad umbrella organization with a complete service offering that covers all facets of Power Generation through the entire Electrical Delivery system. For over 40 years, our diverse services have been focused on...
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Family Advocacy Clinician II
1 month ago
Columbus, Ohio, United States Nationwide Childrens Hospital Full timeThe Center for Family Safety and Healing - Adult Clinician provides assessment and treatment to adults who have experienced intimate partner violence.The clinician works within the context of a multidisciplinary team setting and is responsible for timely reporting, documentation, and participation in treatment and case plan development at the Center.The...
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Customer Success Utilization Manager
6 days ago
Columbus, United States KARL STORZ Endoscopy - America Full timeI. Job Purpose and Core Tasks The Customer Success Utilization Manager plays a critical role in managing overall success, effectiveness, and adoption of the technologies installed (hardware and software of Operation Room/Video installation projects) within their respective regions. This role will be responsible for delivering key roadmaps for brand...
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Dermatology - Clinician Scientist
4 weeks ago
Columbus, United States The Ohio State University Full timeScreen reader users may encounter difficulty with this site. For assistance with applying, please contact hr-accessibleapplication@osu.edu. If you have questions while submitting an application, please review these frequently asked questions. Current Employees and Students: If you are currently employed or enrolled as a student at The Ohio State...