• Behavioral Health Utilization…

    Actalent (Sunrise, FL)
    Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing ... department activities as assigned. Essential Skills + Experience in utilization management, behavioral health , and...mental health . + Proficiency in clinical and utilization review processes. + Current unrestricted Florida… more
    Actalent (10/02/25)
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  • 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 (10/01/25)
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  • Utilization Review Clinician

    Monte Nido (Miami, FL)
    …while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been ... within an intimate home setting. We are seeking a Utilization Review Clinician to join our team...+ Leverage understanding of medical necessity criteria and current behavioral health insurance landscape in verbal and… more
    Monte Nido (09/06/25)
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  • Utilization Review Clinician - ABA

    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
    Centene Corporation (09/18/25)
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  • Medical Director, Behavioral Health…

    Molina Healthcare (St. Petersburg, FL)
    …dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to ... -related regional medical necessity reviews and cross coverage. * Standardizes behavioral health -related utilization management, quality, and financial… more
    Molina Healthcare (10/03/25)
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  • Behavioral Health Care Manager II

    Elevance Health (FL)
    ** Behavioral Health Care Manager II** A proud member of the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health ... for employment, unless an accommodation is granted as required by law. The ** Behavioral Health Care Manager II** is responsible for managing psychiatric and… more
    Elevance Health (09/30/25)
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  • Medical Director, Behavioral Health…

    Molina Healthcare (Tampa, FL)
    **JOB DESCRIPTION** **Job Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management ... and chemical dependency services and assists with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides… more
    Molina Healthcare (09/13/25)
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  • Behavioral Medical Director - Florida

    Centene Corporation (Tallahassee, FL)
    …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization … more
    Centene Corporation (09/04/25)
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  • Care Review Clinician, Prior Authorization

    Molina Healthcare (St. Petersburg, FL)
    …degree in a healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 ... good standing, such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians...in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management… more
    Molina Healthcare (09/18/25)
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  • Medical Director

    Centene Corporation (Tallahassee, FL)
    …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization … more
    Centene Corporation (10/03/25)
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