Behavioral Health Utilization Nurse

A company is looking for a Utilization Management Nurse with a Behavioral Health focus (Remote). Key Responsibilities Review provider submissions for prior service authorizations, focusing on behavioral health Evaluate requests for medical necessity and appropriate service levels Collaborate with internal departments to ensure continuity of care and maintain productivity standards Required Qualifications Active, unrestricted RN, LPN, LCSW, or LPC license in any U.S. state Completion of an accredited Registered Nursing program or equivalent experience 2 years of clinical experience, preferably in hospital nursing, utilization management, or case management Understanding of state and federal healthcare regulations Experience with InterQual and NCQA standards

Apr 1, 2025 - 20:09

A company is looking for a Utilization Management Nurse with a Behavioral Health focus (Remote). Key Responsibilities Review provider submissions for prior service authorizations, focusing on behavioral health Evaluate requests for medical necessity and appropriate service levels Collaborate with internal departments to ensure continuity of care and maintain productivity standards Required Qualifications Active, unrestricted RN, LPN, LCSW, or LPC license in any U.S. state Completion of an accredited Registered Nursing program or equivalent experience 2 years of clinical experience, preferably in hospital nursing, utilization management, or case management Understanding of state and federal healthcare regulations Experience with InterQual and NCQA standards