• Utilization Review Clinician…

    Centene Corporation (Tallahassee, FL)
    …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 (07/31/25)
    - Related Jobs

  • Utilization Review Clinician - ABA

    Centene Corporation (Tallahassee, FL)
    …experience in applied behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / ... health clinicians preferred. Behavioral health clinical knowledge and ability to review ...Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with… more
    Centene Corporation (08/02/25)
    - Related Jobs

  • Utilization Review Clinician…

    Monte Nido (Miami, FL)
    …lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - EST or CST hours** ... strategies to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting daily administrative… more
    Monte Nido (06/21/25)
    - Related Jobs

  • Behavioral Health Care Coordinator

    Actalent (Sunrise, FL)
    Actalent is Hiring a Behavioral Health Care Coordinator // Hybrid!Job Description The Behavioral Health Care Coordinator plays a pivotal role as a core ... mental and physical health care of enrollees within an assigned behavioral health population caseload. The coordinator collaborates with medical providers… more
    Actalent (07/24/25)
    - Related Jobs

  • Behavioral Health Clinical Liaison

    Centene Corporation (Tallahassee, FL)
    …a fresh perspective on workplace flexibility. Job Description **Centene is Hiring: Remote Behavioral Health Clinical Liaison (Florida)** **Centene is seeking a ... Behavioral Health Clinical Liaison to join our Sunshine ...the Operations and Medical Management teams. Assesses and performs review of member clinical records and services related to… more
    Centene Corporation (08/08/25)
    - Related Jobs

  • Utilization Management Nurse

    CenterWell (Tallahassee, FL)
    …best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can ... part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN...medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
    CenterWell (08/08/25)
    - Related Jobs

  • Utilization Management Nurse

    CenterWell (Tallahassee, FL)
    …best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can ... part of our caring community and help us put health first** Healthcare isn't just about health ...medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
    CenterWell (08/02/25)
    - Related Jobs

  • Supervisor, Care Review (RN)

    Molina Healthcare (FL)
    …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization management… more
    Molina Healthcare (07/27/25)
    - Related Jobs

  • Care Review Clinician, ABA (Licensed…

    Molina Healthcare (FL)
    …facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need ... disorders. * Approves prior authorization requests for BHT treatment by reviewing Behavioral Health Therapy (BHT) assessments and treatment plans for medical… more
    Molina Healthcare (07/24/25)
    - Related Jobs

  • Care Review Clinician, PA (RN)

    Molina Healthcare (St. Petersburg, FL)
    …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
    Molina Healthcare (08/08/25)
    - Related Jobs