Utilization Management Nurse Consultant - Behavioral Health
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American Health Holding, Inc.Managed care
Source API remote eligibility restrictions: United States, Work hours: Monday-Friday 11:30am-8:00pm EST. Mandatory 3-week training: Monday–Friday, 8:30am–5:00pm EST, with 100% participation.Full-TimeMiddle
Salary$29.10 - $62.32. This pay range represents the base hourly rate
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Job Details
- Experience
- 3+ years of acute behavioral health and/or substance abuse clinical nursing experience; 1+ year of concurrent review or prior authorization, preferably in Behavioral Health and Substance Abuse. Preferred: 1+ years Managed Care (MCO) experience and 1+ year in a high-volume clinical call center environment.
Requirements
- Hold an active, unrestricted state Registered Nurse license in your state of residence.
- Have an associate's degree in nursing (RN); a BSN is preferred.
- Have at least 3 years of acute behavioral health and/or substance abuse clinical nursing experience.
- Have at least 1 year of concurrent review or prior authorization experience, preferably in Behavioral Health and Substance Abuse.
- Attend mandatory 3-week training Monday–Friday, 8:30am–5:00pm EST, with 100% participation.
- Be able to work occasional rotational weekend on-call coverage and some rotational holiday on-call coverage.
- Be proficient with computer skills and navigating multiple systems.
- Have a dedicated workspace free of interruptions.
- Ensure dependents have separate care arrangements during work hours; continuous care responsibilities during shift times are not permitted.
- Preferred: at least 1 year of Managed Care (MCO) experience.
- Preferred: at least 1 year of experience in a high-volume clinical call center environment.
- Remote work experience is preferred.
Responsibilities
- Apply critical thinking, evidence-based clinical criteria, and clinical practice guidelines to inpatient and outpatient services requiring precertification.
- Use specific utilization management criteria to authorize procedures and services.
- Initiate a Medical Director referral when needed.
- Collect and review clinical information from providers.
- Navigate multiple computer systems and maintain accurate documentation.
- Provide occasional rotational on-call coverage on weekends and holidays.
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