• BH Utilization Review Clinician

    Commonwealth Care Alliance (Boston, MA)
    013650 CCA-Auth & Utilization Mgmt **Position Summary:** The Sr Clinician, Behavioral Health Utilization Review will review behavioral ... behavioral health managed care preferred + Experience in behavioral health utilization review or medical necessity evaluation preferred… more
    Commonwealth Care Alliance (05/21/25)
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  • Utilization Review Specialist…

    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
    Brockton Hospital (07/17/25)
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  • Behavioral Health Clinical Quality…

    Elevance Health (Baton Rouge, LA)
    …and a minimum of 3 years experience in quality improvement and/or behavioral health , risk management and/or utilization review in a managed care setting ... studies including, but not limited to the development and implementation of behavioral health outcomes improvement interventions such as newsletter article,… more
    Elevance Health (07/03/25)
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  • Utilization Review Clinician…

    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
    Centene Corporation (07/19/25)
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  • Utilization Review Specialist,…

    Sutter Health (Berkeley, CA)
    …staff changes, workload, or technical development)._ **DEPARTMENT REQUIRED EDUCATION** Department, Behavioral Health : Master's in Social Work or related field ... with hospital administration, medical staff, patient registration and representatives of review organizations and others to ensure effective utilization of… more
    Sutter Health (06/13/25)
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  • Clinician, Central Access Team

    Eastern Connecticut Health Network (Manchester, CT)
    …EXPERIENCE: + Minimum of ten (10) years of experience in the Behavioral Health field with Utilization Review required. + Must have experience in ... This position is responsible for maximizing access to inpatient behavioral health care and patient movement for...with Director of CAT, Nurse Managers, Crisis Services, and Utilization Review . Responsible for patient movement across… more
    Eastern Connecticut Health Network (05/03/25)
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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 (06/05/25)
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  • Utilization Review Intake RN…

    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
    AdventHealth (06/13/25)
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  • Care Manager MSW - Usfhp

    Pacific Medical Centers (Renton, WA)
    …ongoing + 5 years Clinical experience. + 2 years In a Behavioral Health setting. + Utilization review /case management. **Why Join Providence?** Our ... Managed Care patient in order to assure cost effective, appropriate utilization of health care resource. Case Manager manages, directs, and coordinates the… more
    Pacific Medical Centers (07/23/25)
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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 (07/23/25)
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