Behavioral Health Utilization Nurse

Job Summary

A company is looking for a Utilization Management Nurse with a Behavioral Health focus (Remote).

Key Responsibilities

• Review provider submissions for prior service authorizations, focusing on behavioral health
• Evaluate requests for medical necessity and appropriate service levels
• Collaborate with internal departments to ensure continuity of care and maintain productivity standards

Required Qualifications

• Active, unrestricted RN, LPN, LCSW, or LPC license in any U.S. state
• Completion of an accredited Registered Nursing program or equivalent experience
• 2 years of clinical experience, preferably in hospital nursing, utilization management, or case management
• Understanding of state and federal healthcare regulations
• Experience with InterQual and NCQA standards