Utilization Management Nurse – Behavioral Health Focus (Remote)

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.

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