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Posted 7 days ago
Requirements and responsibilities
Job Title: RN- Utilization Management Nurse
Duration: 4 plus month with possible Extension
Location- Remote/Telehealth
Pay Range: $35.00- $40.00/hr
Top 2 Skills
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.
The Utilization Management Clinical Consultant (UMCC) applies clinical expertise and evidence-based criteria to assess the medical necessity, appropriateness, and quality of behavioral health services for adult and child/adolescent members.
This role supports appropriate utilization of benefits across the continuum of care through collaboration, clinical review, and stakeholder communication.
Review clinical information and apply medical necessity criteria, clinical guidelines, policies, and professional judgment to render coverage determinations and discharge planning decisions.
M-F 8am-5pm AZ time
Fully remote (never coming onsite)
Optionally, you can add more information later (benefits, pre-screening questions, etc.)