Utilization Management Nurse Consultant – Behavioral Health
Description:
• Apply critical thinking and evidence-based clinical criteria specific to Behavioral Health to evaluate inpatient and outpatient services requiring precertification
• Conduct clinical reviews via phone and electronic documentation, collaborating with healthcare providers to gather necessary information
• Use established guidelines to authorize services or escalate to Medical Directors as needed
• Navigate multiple computer systems efficiently while maintaining accurate documentation
• Thrive in a fast-paced, high-volume environment with strong organizational, multitasking, and prioritization skills
• Perform sedentary work with extended periods of sitting, frequent talking, listening, and computer use
• Provide coverage for other UM Nurses across various UM specialty teams as needed
• Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements
Requirements:
• Active, unrestricted RN license in state of residence with multistate/compact licensure privileges
• Ability to obtain licensure in non-compact states as needed
• Minimum 5 years of relevant experience in Nursing
• Minimum 3 years of clinical experience in Behavioral Health and/or substance abuse including acute care, residential treatment center, partial hospitalization and intensive outpatient programs
• At least 1 year of Utilization Management experience in concurrent review or prior authorization
• Strong decision-making skills and clinical judgment in independent scenarios
• Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms
• Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost wellness programs (wellness screenings, tobacco cessation, weight management)
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access
Apply Now
Apply Now
• Apply critical thinking and evidence-based clinical criteria specific to Behavioral Health to evaluate inpatient and outpatient services requiring precertification
• Conduct clinical reviews via phone and electronic documentation, collaborating with healthcare providers to gather necessary information
• Use established guidelines to authorize services or escalate to Medical Directors as needed
• Navigate multiple computer systems efficiently while maintaining accurate documentation
• Thrive in a fast-paced, high-volume environment with strong organizational, multitasking, and prioritization skills
• Perform sedentary work with extended periods of sitting, frequent talking, listening, and computer use
• Provide coverage for other UM Nurses across various UM specialty teams as needed
• Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements
Requirements:
• Active, unrestricted RN license in state of residence with multistate/compact licensure privileges
• Ability to obtain licensure in non-compact states as needed
• Minimum 5 years of relevant experience in Nursing
• Minimum 3 years of clinical experience in Behavioral Health and/or substance abuse including acute care, residential treatment center, partial hospitalization and intensive outpatient programs
• At least 1 year of Utilization Management experience in concurrent review or prior authorization
• Strong decision-making skills and clinical judgment in independent scenarios
• Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms
• Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost wellness programs (wellness screenings, tobacco cessation, weight management)
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access
Apply Now
Apply Now