• Behavioral Health Utilization

    HCA Healthcare (Nashville, TN)
    **Description** **Introduction** Do you have the career opportunities as a Behavioral Health Utilization Review Specialist you want with your current ... a committed, caring group of colleagues. Do you want to work as a Behavioral Health Utilization Review Specialist where your passion for creating… more
    HCA Healthcare (04/25/25)
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  • Behavioral Health Utilization

    HCA Healthcare (Nashville, TN)
    …**Introduction** Do you want to join an organization that invests in you as a Behavioral Health Utilization Review Specialist? At Parallon, you come ... you have the opportunity to make a difference. We are looking for a dedicated Behavioral Health Utilization Review Specialist like you to be a part of… more
    HCA Healthcare (04/25/25)
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  • Utilization Review Clinician…

    Centene Corporation (New York, NY)
    …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and...health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review more
    Centene Corporation (04/20/25)
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  • Utilization Review (UR) Supervisor

    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
    Spectrum Billing Solutions (04/01/25)
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  • Utilization Review Clinician

    Novant Health (Winston Salem, NC)
    Review Clinician serves as a leader resource in the Utilization Review process for Behavioral Health acute care . They collaborate with physicians ... Degree in Nursing/Social Work/Counseling, preferred. + Experience: Minimum of two years Behavioral Healthcare experience and Utilization Review or related… more
    Novant Health (04/30/25)
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  • Consultant, Behavioral Health

    Lincoln Financial (Columbus, OH)
    …1 year in claims, disability management (STD/LTD), worker's compensation, utilization review , and or behavioral health case management . Certified ... are excited to bring on a knowledgeable and motivated Behavioral Health Consultant to our Clinical Organization....disability claims. You will act as a resource to review , analyze, and interpret medical information as well as… more
    Lincoln Financial (04/17/25)
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  • Utilization Management Behavioral

    Humana (Columbus, OH)
    …+ Experience with utilization review process. + Experience with behavioral change, health promotion, coaching and wellness. + Knowledge of community ... health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral more
    Humana (04/09/25)
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  • Supervisor, Behavioral Health

    Centene Corporation (Phoenix, AZ)
    …Arizona for this remote position.** **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care ... BH utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines +… more
    Centene Corporation (04/09/25)
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  • Utilization Management Clinical Consultant…

    CVS Health (Baton Rouge, LA)
    utilization /benefit management function. **Required** **Qualifications** - Licensed independent Behavioral Health clinician (ie LCSW, LCPC, LMFT, LPCC, LPAT, ... schedules. ​ **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 (04/25/25)
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  • Behavioral Health

    CVS Health (Frankfort, KY)
    utilization /benefit management program. **Required Qualifications** + Licensed independent behavioral health clinician with Kentucky state licensure (LCSW, ... anywhere in the United States. The requirements is for candidates to hold a Behavioral health clinician or Registered Nursing with Kentucky state or compact… more
    CVS Health (04/05/25)
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  • Utilization Management Clinician…

    CVS Health (Raleigh, NC)
    …operation and work schedules will include weekends, holidays, and evening hours._ As a Utilization Management Clinician - Behavioral Health you will utilizes ... and keyboarding + Must have active current and unrestricted Behavioral Health clinical licensure (LPC, LMSW, LSW,...and substance abuse disorders + Managed care experience + Utilization review experience + Crisis intervention skills… more
    CVS Health (04/30/25)
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  • Manager, Utilization Management…

    Humana (Frankfort, KY)
    …our caring community and help us put health first** The Manager, Behavioral Health Utilization Management uses clinical knowledge, communication skills, ... managers across the department. **_Detailed Responsibilities include:_** Leads Kentucky Medicaid Behavioral Health Utilization Management process and teams… more
    Humana (04/26/25)
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  • Behavioral Health Utilization

    AmeriHealth Caritas (Charleston, SC)
    …www.amerihealthcaritas.com . **Responsibilities:** Under the direction of the Supervisor, the Behavioral Health Utilization Management Reviewer is ... all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer's discretion...+ Minimum of 2 years of behavioral health and substance use disorder experience.; + Utilization more
    AmeriHealth Caritas (03/18/25)
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  • Case Manager Utilization Review

    Beth Israel Lahey Health (Burlington, MA)
    …you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in Burlington ... 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
    Beth Israel Lahey Health (04/16/25)
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  • Director of Utilization Review

    BriteLife Recovery (Englewood, NJ)
    …experience in utilization review , case management, or clinical oversight in a behavioral health or substance use treatment setting. At least 2 years in a ... What you will be doing? The Director of Utilization Review is responsible for overseeing all utilization review activities to ensure that clients receive… more
    BriteLife Recovery (04/24/25)
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  • Utilization Review Tech II - Social…

    Prime Healthcare (Passaic, NJ)
    …reviews and appeals. Document and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all ... program for cancer care. The hospital is also a center of excellence for maternal-child health and outpatient behavioral health services. It is the only… more
    Prime Healthcare (04/18/25)
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  • Utilization Review /Appeals…

    Centene Corporation (Tallahassee, FL)
    …state required licensure as outlined by the applicable state required. Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment ... of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder...Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with… more
    Centene Corporation (04/03/25)
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  • Utilization Review Specialist (LVN)

    Bakersfield Behavioral Healthcare Hospital (Bakersfield, CA)
    …Education Associates Degree preferred Minimum Work Experience Utilization Review experience preferably in a behavioral /psychiatric healthcare setting or ... and outpatient services for children, adolescents and adults needing mental/ behavioral health , chemical dependency; and co-occurring disorders treatment… more
    Bakersfield Behavioral Healthcare Hospital (02/19/25)
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  • Utilization Management Review Nurse

    AmeriHealth Caritas (Dover, DE)
    …Director for further review . The reviewer independently applies medical and behavioral health guidelines to authorize services, ensuring they meet the ... managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover… more
    AmeriHealth Caritas (04/29/25)
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  • Utilization Review (UR) Specialist

    Spectrum Billing Solutions (Skokie, IL)
    …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing team. The UR Specialist ... 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
    Spectrum Billing Solutions (02/05/25)
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