Morgan Stephens
Job Title: Utilization Management Nurse – Behavioral Health Focus (Remote) Location Requirements: Candidates must be located in one of the following preferred states: Arizona (AZ), Florida (FL), Georgia (GA), Idaho (ID), Iowa (IA), Kentucky (KY), Michigan (MI), Nebraska (NE), New Mexico (NM), New York (NY – outside greater NYC), Ohio (OH), Texas (TX), Utah (UT), Washington (WA – outside greater Seattle), or Wisconsin (WI). Time Zone Preference: Eastern Time Zone is preferred, but not required. Work Schedule: Tuesday through Saturday, 8:00 AM – 5:00 PM EST 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.
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 in any U.S. state 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
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
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