Utilization Management Nurse – Behavioral Health Focus (Remote)

Morgan Stephens; Phoenix (AZ); Remote; USD 1,000; Full time

Job summary

A leading organization is seeking a Utilization Management Nurse focusing on behavioral health. This role involves reviewing provider-submitted authorization requests to ensure timely member care while ensuring medical necessity. The ideal candidate will have clinical experience and a valid nursing license, working Tuesday through Saturday with a competitive salary.

Qualifications

• Active RN, LPN, LCSW, or LPC license required.
• 2 years of clinical experience preferred in hospital nursing or utilization management.

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.

Skills

Organizational skills

Communication skills

Problem-solving skills

Education

Completion of an accredited Registered Nursing program

Tools

Microsoft Office

Electronic documentation systems

Job description

Join to apply for the Utilization Management Nurse – Behavioral Health Focus (Remote) role at Morgan Stephens

Join to apply for the Utilization Management Nurse – Behavioral Health Focus (Remote) role at Morgan Stephens

Get AI-powered advice on this job and more exclusive features.

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

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Staffing and Recruiting

Referrals increase your chances of interviewing at Morgan Stephens by 2x

Get notified about new Nurse jobs in Phoenix, AZ.

Care Review Clinician, PA (RN) (Must work PST)

Subject Matter Expert – Practical Nursing

Associate Director, RN Medical Management Services

Subject Matter Expert – Practical Nursing, (part time up to full time hours)

Clinical Nurse Educator (Remote) CST, MST, PST

Nurse Practitioner - Hormones, Peptides, and Longevity (Telehealth)

Sr. Specialist, Quality Program Management & Performance RN (RN Required, BSN Preferred, must reside in AZ)

Call Center: Telecare Registered Nurse (RN) (REMOTE)

Prior Authorization Specialist - Part-Time

Call Center: Telecare Registered Nurse (RN) (REMOTE)

Registered Nurse - RN / Progressive Care Unit - TELE-P

Phoenix, AZ $101,000.00-$129,000.00 2 weeks ago

CA Workers Comp - Telephonic Nurse Case Manager (Remote)

Scottsdale, AZ $80,000.00-$88,000.00 17 hours ago

Associate Faculty - Nurse Practitioner Women's Health Management - Part Time Faculty (Virtual)

Nurse Practitioner - Full Time Regional Traveler

Phoenix, AZ $124,300.00-$144,700.00 3 days ago

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.