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Posted 6 days ago
Requirements and responsibilities
Job Title: RN- Utilization Management -(Behavioral Health)
Duration: 4 plus month with possible extension
Location: Fully Remote
Pay Range: $35- 40.00/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.
Educate providers, under appropriate supervision, on utilization management processes, documentation requirements, and applicable guidelines.
Standard schedule: Monday–Friday, 8:00 AM–5:00 PM Arizona time.
• Occasional holiday or weekend coverage required through rotation.
1. Behavioral Health Utilization Management
Ability to review clinical information, apply medical necessity guidelines, and make UM decisions (initial, concurrent, and discharge planning).
Includes strong discharge planning skills to support safe, appropriate transitions of care.
2. Clinical Assessment & Critical Thinking
Skilled in evaluating clinical needs, reviewing records, and making sound decisions that balance quality, cost, and member-centered care.
Must have a strong understanding of community behavioral health resources to support referrals and continuity of care.
M-F 8am-5pm AZ time
Optionally, you can add more information later (benefits, pre-screening questions, etc.)