• Utilization Review Clinician

    Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
    …mental health and co-occurring psychiatric and substance abuse conditions. POSITION TITLE: Utilization Review Clinician PAY RANGE: LVN/LPT $31.50-37.50 Per ... monitor and optimize reimbursement for external reviewers/third party payers. The Utilization Review Clinician maintains knowledge of, participates… more
    Sacramento Behavioral Healthcare Hospital (10/24/25)
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  • Utilization Review Clinician

    Centene Corporation (Honolulu, HI)
    …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... Remote Position. Must Reside in Hawaii Registered Nurse (RN) or Licensed Clinician Only. Must have a current state's license **Must have Behavioral Health… more
    Centene Corporation (10/30/25)
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  • Associate Medical Director

    CenterWell (Columbia, SC)
    …clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify ... of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and...and monitor clinical & financial performance and metrics + Review clinician schedules and incentive plans to… more
    CenterWell (09/25/25)
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  • Associate Medical Director

    CenterWell (San Antonio, TX)
    …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify ... and operational budgeting, and monitor clinical & financial performance and metrics. * Review clinician schedules and incentive plans to align with patient… more
    CenterWell (11/15/25)
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  • Associate Medical Director

    CenterWell (Hampton, VA)
    …clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization . + Periodically review clinician charts to identify ... of health (SDOH) efforts, improving clinical outcomes and avoidable utilization . + Monitor and manage daily patient care and...and monitor clinical & financial performance and metrics. + Review clinician schedules and incentive plans to… more
    CenterWell (10/29/25)
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  • Chief Medical Officer

    CenterWell (Arlington, TX)
    …clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify ... and operational budgeting, and monitor clinical & financial performance and metrics. + Review clinician schedules and incentive plans to align with patient care… more
    CenterWell (11/12/25)
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  • RN Care Review Clinician Remote

    Molina Healthcare (NY)
    **JOB DESCRIPTION** The Care Review Clinician (RN) provides support for clinical member services review assessment processes. Responsible for verifying that ... Candidates with MCO experience are highly preferred. The Care Review Clinician must be able to work...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** *… more
    Molina Healthcare (11/14/25)
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  • RN Care Review Clinician Critical…

    Molina Healthcare (Bothell, WA)
    JOB DESCRIPTION Job Summary The Care Review Clinician (RN) provides support for clinical member services review assessment processes. Responsible for ... and critical care experience, ie ER or ICU. Candidates with Utilization Management and med/surge experience are highly preferred. Exceptional time management… more
    Molina Healthcare (11/13/25)
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  • RN Care Review Clinician Remote

    Molina Healthcare (NM)
    JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for ... cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday 8:00am- 5:00pm PST. This… more
    Molina Healthcare (11/09/25)
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  • Care Review Clinician (BH Licensed)

    Molina Healthcare (Louisville, KY)
    …RN who must be licensed in KY or have a compact RN license. The Care Review Clinician Inpatient Review BH will provide prior authorization for outpatient and ... JOB DESCRIPTION Job Summary Provides support for member clinical service review processes specific to behavioral health. Responsible for verifying that services… more
    Molina Healthcare (11/09/25)
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