- Brockton Hospital (Brockton, MA)
- POSITION SUMMARY: The Utilization Review Specialist - Behavioral Health works collaboratively with Administration, Coding, Physicians, Nursing, Social ... entities to secure certification/ reimbursement. Maintains data for required auditing, utilization review , reporting and performance improvement. As prescribed… more
- Centene Corporation (San Antonio, TX)
- …health and substance abuse is preferred. + Utilization Review / Utilization management with behavioral health cases + Precertification, Concurrent ... accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH)...and substance abuse is preferred. + Knowledge of mental health and substance abuse utilization review… more
- Centene Corporation (Raleigh, NC)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... WORK 10 HOURS.** **THIS ROLE WILL MAINLY SUPPORT MEDICARE BEHAVIORAL HEALTH ALL STATES AND DELAWARE MEDICAID...health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review… more
- AdventHealth (Glendale Heights, IL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use...+ Associate's of Nursing Required + RN experience in behavioral health preferred + Must be able… more
- Spectrum Billing Solutions (Skokie, IL)
- …conference reviews. Minimum requirements: + 3-5 years of experience in utilization review for behavioral health services. + Bachelor's or Master's ... for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing...(Word, Excel, billing software). + Understanding of mental and behavioral health treatment services. At Spectrum, you… more
- UnityPoint Health (Cedar Rapids, IA)
- …regarding managed care implications - precertification and utilization review procedures. . Provides consultation regarding behavioral health ... the assessment, planning, implementation and evaluation of patient care on the behavioral health units. Responsible for the delivery of patient care through a… more
- CVS Health (Charleston, WV)
- …the utilization /benefit management function. Required Qualifications: + Licensed independent Behavioral Health clinician or a Registered Nurse (RN) with ... setting required Preferred Qualifications: + Managed care/ utilization review experience preferred + Experience in a behavioral... review experience preferred + Experience in a behavioral health inpatient setting + Ability to… more
- CVS Health (Frankfort, KY)
- …clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. ... /benefit management function. **Required Qualifications** + **_Kentucky Licensed Independent Behavioral Health Clinician (_** **_LPCC, LCSW, LMFT, LPAT_**… more
- Beth Israel Lahey Health (Burlington, MA)
- …making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse (RN) Case ... Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality...review medical necessity and discharge planning) **As a health care organization, we have a responsibility to do… more
- UnityPoint Health (Cedar Rapids, IA)
- …+ Job ID: 168048 Overview The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a key role in coordinating ... the department's interdisciplinary effort to assess and promote appropriate utilization of health care resources, provision of...related field or an RN + Two years of behavioral health work experience. + Professional communication… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review Full Time Days -...preferred. At least two (2) years acute hospital or Behavioral Health patient care experience required. One ... level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as...(1) year hospital acute or behavioral health case management experience preferred. Active… more
- Centene Corporation (Tallahassee, FL)
- …degree for behavioral health clinicians preferred. Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans ... of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder...required. Knowledge of ABA services and BH utilization review process required. Experience working with… more
- LifePoint Health (Louisburg, NC)
- Registered Nurse (RN) Utilization Review Job Type: Full Time | Day Your experience matters At Maria Parham Hospital, we are driven by a profound commitment to ... text outlines the responsibilities involved in monitoring adherence to the hospital's utilization review plan, which ensures the appropriate use of hospital… more
- US Tech Solutions (Columbia, SC)
- … health /chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years must ... Utilization management experience and /or Appeals experience /strong clinical skills Behavioral Health or infusion therapy experience + A typical day would… more
- BriteLife Recovery (Englewood, NJ)
- …in utilization review , case management, or insurance coordination in a behavioral health or substance use treatment setting. + Knowledge of ASAM criteria ... What you will be doing? The Utilization Review (UR) Specialist is a...and a working knowledge of insurance guidelines specific to behavioral health What tasks are required? +… more
- AmeriHealth Caritas (LA)
- …Director for further review . The reviewer independently applies medical and behavioral health guidelines to authorize services, ensuring they meet the ... efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team. The Utilization ... clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and...(Word, Excel, billing software). + Understanding of mental and behavioral health treatment services. At Spectrum, you… more
- AmeriHealth Caritas (Washington, DC)
- …Director for further review . The reviewer independently applies medical and behavioral health guidelines to authorize services, ensuring they meet the ... efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- State of Connecticut, Department of Administrative Services (New Haven, CT)
- Utilization Review Nurse (40 Hour) Office/On-Site Recruitment # 250715-5612FP-001 Location New Haven, CT Date Opened 7/22/2025 12:00:00 AM Salary $78,480 - ... overall health and wellness of persons with behavioral health needs through an integrated network...medical care delivery and reimbursement systems; + Participates in utilization review and/or quality assurance programs; +… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …health and co-occurring psychiatric and substance abuse conditions. POSITION TITLE: Utilization Review Clinician PAY RANGE: LVN/LPT $31.50-37.50 Per Hour ... of the greater Santa Rosa and Northern California mental health system of care. Conveniently located in the North...RN/LCSW/LMFT/LPCC $54.00-64.00 Per Hour REPORTS TO: Director of Utilization Review DESCRIPTION OF POSITION: Work as… more