Utilization Review Specialist
2 weeks ago
Apply Description About the Role The Utilization Review Specialist supports timely, appropriate patient care by managing utilization review activities across inpatient, outpatient, and residential services. This role coordinates authorizations, reviews clinical documentation, ensures medical necessity, and serves as a key liaison between treatment teams, Medicaid, and private insurance payors.Ideal CandidateStrong clinical understanding of mental health and level-of-care criteria. Experienced with Medicaid/private insurance authorizations, pre-auths, and appeals. Highly organized, detail-oriented, and able to manage multiple referrals and deadlines. Excellent written and verbal communication; professional, clear, and collaborative. Calm under pressure, compassionate with youth and families, and maintains a positive demeanor. Proficient in Epic, insurance portals, and standard office software. Why Join Shodair? You’ll be part of a collaborative, mission-driven team dedicated to improving access to mental health services for children and families across Montana. Shodair offers comprehensive benefits including student loan assistant, 6% 403b employer paid contribution, paid medical and vision insurance, sick leave, and much more. This position starts at $23.65 per hour. Requirements QualificationsBachelor’s degree in social work, psychology, nursing, or related field (or equivalent experience). Experience in mental health or crisis intervention preferred. Salary Description Starting at $23.65 per hour
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Utilization Review Specialist
7 days ago
Helena, United States Shodair Children's Hospital Full timeAbout the RoleThe Utilization Review Specialist supports timely, appropriate patient care by managing utilization review activities across inpatient, outpatient, and residential services. This role coordinates authorizations, reviews clinical documentation, ensures medical necessity, and serves as a key liaison between treatment teams, Medicaid, and private...
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Utilization Review RN
5 days ago
Helena, United States Montana Staffing Full timeUtilization Management RN The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN supports the UR RN Coordinator and other UR team members in providing all identified utilization review functions for the organization to ensure cost effective care delivery. The UR LPN is responsible for completing utilization reviews,...
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Utilization Review RN
2 days ago
Helena, MT, United States St. Peter's Health Full timeJob Description The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN supports the UR RN Coordinator and other UR team members in providing all identified utilization review functions for the organization to ensure cost effective care delivery. The UR LPN is responsible for completing utilization reviews, referral to...
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Utilization Review RN
6 days ago
Helena, MT, United States St. Peter's Health Full timeJob Description The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN supports the UR RN Coordinator and other UR team members in providing all identified utilization review functions for the organization to ensure cost effective care delivery. The UR LPN is responsible for completing utilization reviews, referral to...
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Cardiology Utilization
3 weeks ago
Helena, United States Evolent Full timeA leading healthcare provider seeks a Nurse Practitioner or Physician Assistant to join their cardiology team in Helena, Montana. This role involves clinical liaison work and requires a Master's degree in Nursing or a DNP. Ideal candidates will have a minimum of five years' experience in cardiology or primary care and must hold a current state license. Work...
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Medical Reviewer LPN
1 day ago
Helena, MT, United States Health Care Service Corporation Full timeAt HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This position is responsible for...
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Medical Reviewer LPN
15 hours ago
Helena, MT, United States Health Care Service Corporation Full timeAt HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This position is responsible for...
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Asset Protection Specialist
2 weeks ago
Helena, United States Montana Staffing Full timeAsset Protection SpecialistPosition Purpose: The Asset Protection Specialist is primarily responsible for preventing financial loss caused by theft and fraud and supporting safety and environmental program compliance in their assigned store/multiple stores. They utilize tools to minimize loss to the Company, including but not limited to identifying incidents...
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PROGRAM ELIGIBILITY SPECIALIST I
2 weeks ago
Helena, AR, United States State of Arkansas Full timePROGRAM ELIGIBILITY SPECIALIST I Date: Dec 5, 2025 Req ID: 52586 Location: Helena, AR, US, 72390 Category: AR DEPT OF HUMAN SERVICES Anticipated Starting Salary: $47,397.00 Position Number: 22101019 County: Phillips Posting End Date: 12/11/2025 DCO Hiring Official: Brenda Messenger Minimum Qualifications (from OPM Job Specification) The formal education...
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PROGRAM ELIGIBILITY SPECIALIST I
2 weeks ago
Helena, AR, United States State of Arkansas Full timePROGRAM ELIGIBILITY SPECIALIST I Date: Dec 5, 2025 Req ID: 52586 Location: Helena, AR, US, 72390 Category: AR DEPT OF HUMAN SERVICES Anticipated Starting Salary: $47,397.00 Position Number: 22101019 County: Phillips Posting End Date: 12/11/2025 DCO Hiring Official: Brenda Messenger Minimum Qualifications (from OPM Job Specification) The formal education...
