RN-Behavioral Health (Utilization Management)- Remote

LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.

Job Title: RN-Utilization Management Nurse- Behavioral Health Duration: 6 plus month with possible extension Location: Fully Remote Pay Range: $37-$38.00/hr

Review clinical information and apply medical necessity criteria, clinical guidelines, policies, and professional judgment to render coverage determinations and discharge planning decisions. Analyze medical records and clinical data to ensure services align with evidence-based standards and quality benchmarks. Coordinate and communicate with healthcare providers, internal teams, and external stakeholders to facilitate timely, appropriate care and authorization decisions. Conduct concurrent reviews to monitor ongoing inpatient or outpatient treatment and support continuity of care. Identify members who may benefit from care management programs and facilitate appropriate referrals. Provide urgent or emergent clinical interventions when required, including triage and crisis support. Identify opportunities to optimize resource utilization, reduce unnecessary services, and promote cost-effective, high-quality care. Educate providers, under appropriate supervision, on utilization management processes, documentation requirements, and applicable guidelines. Develop and support initiatives that enhance quality effectiveness and benefit utilization. Prepare clinical reports and documentation to communicate findings, monitor key performance indicators, and track utilization management outcomes.