Morgan Stephens

Utilization Management Nurse – Behavioral Health Focus (Remote)

Posted on

May 6, 2025

Job Type

Full-Time

Role Type

Behavioral Health

License

RN

State License

Ohio

Apply to This Job

Help & Resources

Company Description

Job Description

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.

Requirements

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

Need help crafting an effective cover letter and resume for this role?

Get access to our expert resources: our proven framework offers successful strategies, helps you find the best-fit positions, craft standout cover letters, optimize your resume, and much more.

Get Started

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

Apply to This Job

Help & Resources

Our Resources Designed for Success

Nurses who follow our proven framework increase their chances of landing a remote telehealth role by 5x!

Telehealth

Starter Pack

Telehealth

Pro Toolkit

Telehealth

Mastery Suite

Price

$34 $79 $149

Resume Template Package

Checkmark Checkmark Checkmark
Matching Cover Letter Checkmark Checkmark Checkmark
Matching Reference Page Checkmark Checkmark Checkmark
Resume Tips and Tricks Checkmark Checkmark Checkmark
Resume Optimization Guide Checkmark Checkmark
7 Nurse Resume Examples Checkmark Checkmark
20+ Professional Summary Examples Checkmark Checkmark
How to Structure Unique Career Experiences Checkmark Checkmark

✅Career Accelerator Success Guide

Checkmark
🔓Lifetime Premium Job Board Access

Checkmark
📈Job Application Tracker

Checkmark
⭐1:1 Expert Support & Mentorship

Checkmark

Basic

Telehealth

Starter Pack

$34

  • Checkmark

    Resume Template Package

    ATS optimized design for nurses

  • Checkmark

    Matching Cover Letter

  • Checkmark

    Matching Reference Page

  • Checkmark

    Resume Tips and Tricks

ADVANCED

Telehealth

Pro Toolkit

$79

  • Checkmark

    Everything from Starter Pack

  • Checkmark

    Resume Optimization Guide

  • Checkmark

    7 Nurse Resume Examples

  • Checkmark

    20+ Professional Summary Examples

  • Checkmark

    How to Structure Unique Career Experiences

BEST VALUE

Telehealth

Mastery Suite

$149

  • Checkmark

    Everything from Starter Pack

  • Checkmark

    Everything from Pro Toolkit

  • Checkmark

    Career Accelerator Success Guide

    Proven method for landing your dream role

  • Checkmark

    Lifetime Premium Job Board Access

  • Checkmark

    Application Tracker

  • Checkmark

    1:1 Expert Support