Job Description

Job Title: Utilization Management Nurse – Behavioral Health Focus (Remote)
Time Zone Preference
Pacific or Mountain Time Zone is preferred
Work Schedule
Tuesday through Saturday, 8:00 AM – 5:00 PM PST
Compensation
$40 per hour
Position Type
Temporary to Permanent
Position Summary
A Managed Care Organization is seeking a Utilization Management Nurse to review provider-submitted service authorization requests and evaluate medical necessity, with a primary focus on behavioral health services. This position plays a key role in ensuring members receive appropriate and timely care by performing prior authorizations and concurrent reviews.
Day-to-Day Responsibilities
Review provider submissions for prior service authorizations, particularly in behavioral health
Evaluate requests for medical necessity and appropriate service levels
Provide concurrent review and prior authorization according to internal policies
Identify appropriate benefits and determine eligibility and expected length of stay
Collaborate with internal departments, including Behavioral Health and Long Term Care, to ensure continuity of care
Refer cases to medical directors as needed
Maintain productivity and quality standards
Participate in staff meetings and assist with onboarding of new team members
Foster professional relationships with internal teams and provider partners
Must-Have Requirements
Background in Behavioral Health services and/or experience with a Managed Care Organization (MCO) in Utilization Management
Licensure Requirements
Active, unrestricted RN, LPN, LCSW, or LPC license
Required Education And Experience
Completion of an accredited Registered Nursing program (or equivalent combination of experience and education)
2 years of clinical experience, preferably in hospital nursing, utilization management, or case management
Knowledge, Skills, And Abilities
Understanding of state and federal healthcare regulations
Experience with InterQual and NCQA standards
Strong organizational, communication, and problem-solving skills
Proficient in Microsoft Office and electronic documentation systems
Ability to work independently and manage multiple priorities
Professional demeanor and commitment to confidentiality and compliance with HIPAA standards
Team-oriented with the ability to build and maintain positive working relationships

Job Tags

Hourly pay, Permanent employment, Temporary work, Remote job, Saturday,

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