Utilization Management Nurse – Behavioral Health Focus (Remote)

Job Title: Utilization Management Nurse – Behavioral Health Focus (Remote) Time Zone Preference Pacific or Mountain Time Zone is preferred Work Schedule Tuesday through Saturday, 8:00 AM – 5:00 PM PST 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. Day-to-Day Responsibilities • 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 Must-Have Requirements • Background in Behavioral Health services and/or experience with a Managed Care Organization (MCO) in Utilization Management Licensure Requirements • Active, unrestricted RN, LPN, LCSW, or LPC license Required Education And Experience • Completion of an accredited Registered Nursing program (or equivalent combination of experience and education) • 2 years of clinical experience, preferably in hospital nursing, utilization management, or case management Knowledge, Skills, And Abilities • Understanding of state and federal healthcare regulations • Experience with InterQual and NCQA standards • Strong organizational, communication, and problem-solving skills • Proficient in Microsoft Office and electronic documentation systems • Ability to work independently and manage multiple priorities • Professional demeanor and commitment to confidentiality and compliance with HIPAA standards • Team-oriented with the ability to build and maintain positive working relationships Apply Job! Apply to this Job