Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing ...
At least 3-5 years of experience in a Psychiatric Inpatient Setting or 3-5 years of Health Plan or 3-5 years of Managed Behavioral Health experience Utilization Reviews experience. There will be ...
At least 3-5 years of experience in a Psychiatric Inpatient Setting or 3-5 years of Health Plan or 3-5 years of Managed Behavioral Health experience Utilization Reviews experience. There will be ...
Utilization Specialist
Wesley Chapel, FL · On-site
$55 - $75/hr
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing ...
Utilization Specialist
Wesley Chapel, FL · On-site
$55 - $75/hr
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing ...
Utilization Specialist
Wesley Chapel, FL · On-site
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing ...
Utilization Specialist
Wesley Chapel, FL · On-site
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing ...
Concurrent Review Nurse
Doral, FL · On-site
Conduct medical and behavioral health (BH) reviews for pre- and post-service authorization requests ... Minimum of two (2) years of experience in clinical review or utilization management Language Skills
Concurrent Review Nurse
Doral, FL · On-site
Conduct medical and behavioral health (BH) reviews for pre- and post-service authorization requests ... Minimum of two (2) years of experience in clinical review or utilization management Language Skills
Concurrent Review Nurse
Doral, FL · On-site
Conduct medical and behavioral health (BH) reviews for pre- and post-service authorization requests ... Minimum of two (2) years of experience in clinical review or utilization management Language Skills
Concurrent Review Nurse
Doral, FL · On-site
Conduct medical and behavioral health (BH) reviews for pre- and post-service authorization requests ... Minimum of two (2) years of experience in clinical review or utilization management Language Skills
... review. How you will make an impact: * Responsible for providing technical guidance to UM Reps who ... Exemplifies behaviors embodied in the 5 Core Values. * Associates in this role are expected to have ...
... review. How you will make an impact: * Responsible for providing technical guidance to UM Reps who ... Exemplifies behaviors embodied in the 5 Core Values. * Associates in this role are expected to have ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...
Inpatient Utilization Management Specialist
Punta Gorda, FL · On-site
$16.50 - $18.50/hr
Participate in daily treatment team meetings in Crisis Services programs for the purpose of identifying new patients and communicating with them to determine financial income information, behavioral ...
Inpatient Utilization Management Specialist
Punta Gorda, FL · On-site
$16.50 - $18.50/hr
Participate in daily treatment team meetings in Crisis Services programs for the purpose of identifying new patients and communicating with them to determine financial income information, behavioral ...
Inpatient Utilization Management Specialist
$16.50 - $18.50/hr
Participate in daily treatment team meetings in Crisis Services programs for the purpose of identifying new patients and communicating with them to determine financial income information, behavioral ...
Inpatient Utilization Management Specialist
$16.50 - $18.50/hr
Participate in daily treatment team meetings in Crisis Services programs for the purpose of identifying new patients and communicating with them to determine financial income information, behavioral ...
Process and track the progress of Comprehensive Behavioral Health Assessment (CBHA) referrals. Receive completed assessments and process service authorizations once approved. * Cultivates effective ...
Process and track the progress of Comprehensive Behavioral Health Assessment (CBHA) referrals. Receive completed assessments and process service authorizations once approved. * Cultivates effective ...
Healthcare Svcs Review Nurse
Tampa, FL · On-site
$32.84 - $60.18/hr
... behaviors that establishes trust throughout the organization and with the public we serve ... Knowledge of Utilization Review and Case Management policies and procedures. * Knowledge of ...
Healthcare Svcs Review Nurse
Tampa, FL · On-site
$32.84 - $60.18/hr
... behaviors that establishes trust throughout the organization and with the public we serve ... Knowledge of Utilization Review and Case Management policies and procedures. * Knowledge of ...
Healthcare Svcs Review Nurse
Tampa, FL · On-site
$32.84 - $60.18/hr
... behaviors that establishes trust throughout the organization and with the public we serve ... Knowledge of Utilization Review and Case Management policies and procedures. * Knowledge of ...
Healthcare Svcs Review Nurse
Tampa, FL · On-site
$32.84 - $60.18/hr
... behaviors that establishes trust throughout the organization and with the public we serve ... Knowledge of Utilization Review and Case Management policies and procedures. * Knowledge of ...
Behavioral UM Case Manager
Tampa, FL · On-site
Perform duties to authorize and review utilization of mental health and substance abuse services ... Must be an LPC, LCSW, LMFT, or Psychologist Minimum of 3 years' experience in Behavioral Health ...
Behavioral UM Case Manager
Tampa, FL · On-site
Perform duties to authorize and review utilization of mental health and substance abuse services ... Must be an LPC, LCSW, LMFT, or Psychologist Minimum of 3 years' experience in Behavioral Health ...
Care Review Clinician
Miami, FL · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity ... Behavioral Health and Long Term Care. Maintains department productivity and quality measures.
Care Review Clinician
Miami, FL · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity ... Behavioral Health and Long Term Care. Maintains department productivity and quality measures.
Behavioral Utilization Review information
What is the difference between Behavioral Utilization Review vs Behavioral Case Manager?
| Aspect | Behavioral Utilization Review | Behavioral Case Manager |
|---|---|---|
| Credentials | Licensed mental health professionals, certifications vary | Licensed clinical social workers, counselors, or therapists |
| Work Environment | Review settings, insurance companies, healthcare facilities | Direct patient interaction, hospitals, outpatient clinics |
| Employer & Industry | Insurance companies, healthcare organizations | Hospitals, mental health agencies, managed care |
| Primary Focus | Assessing medical necessity, reviewing treatment plans | Coordinating care, supporting treatment adherence |
Behavioral Utilization Review primarily involves evaluating the necessity of mental health services through review processes, while Behavioral Case Managers focus on coordinating patient care and supporting treatment plans. Both roles require mental health credentials but differ in daily tasks and work settings.
How to become a behavioral utilization review?
To become a behavioral utilization review specialist, candidates typically need a bachelor's degree in psychology, social work, nursing, or a related field. Relevant experience in mental health or healthcare settings, along with knowledge of insurance policies and utilization review processes, is important; some roles may require certification such as the Certified Professional in Utilization Review (CPUR).
Is behavioral utilization review a stressful job?
Behavioral utilization review can be stressful due to the need to evaluate complex mental health cases, meet strict deadlines, and handle sensitive patient information. The role often requires strong attention to detail, critical thinking, and emotional resilience, which can contribute to job-related stress.
What are popular job titles related to Behavioral Utilization Review jobs in Florida?
For Behavioral Utilization Review jobs in Florida, the most frequently searched job titles are:
- Full Time Remote Utilization Review Nurse
- Remote Concurrent Review Nurse
- Part Time Utilization Review Nurse
- Insurance Review Nurse
- Freelance Utilization Review Nurse
- Remote Utilization Management
- Prn Utilization Review
- Utilization Review Physician
- Non Exempt No Experience Utilization Management Nurse
- Night Utilization Review Nurse
What job categories do people searching Behavioral Utilization Review jobs in Florida look for?
The top searched job categories for Behavioral Utilization Review jobs in Florida are:
- Full Time Bcba Utilization Review
- Remote Optum Utilization Review
- Utilization Review Assistant
- Remote Navihealth Utilization Review
- Dental Utilization Review
- Work From Home Chiropractic Utilization Review
- Authorization Utilization Review Bcba
- Utilization Review Coordinator Remote
- Lpn Utilization Review Work From Home
- Utilization Review Clinician Salary
What cities in Florida are hiring for Behavioral Utilization Review jobs?
Cities in Florida with the most Behavioral Utilization Review job openings:
Acadia Healthcare rating
6.2
Based on 191 frontline employees who took The Breakroom Quiz
698th of 898 rated healthcare providers
Job description
PURPOSE STATEMENT:
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
ESSENTIAL FUNCTIONS:
- Act as liaison between managed care organizations and the facility professional clinical staff.
- Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
- Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
- Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
- Conduct quality reviews for medical necessity and services provided.
- Facilitate peer review calls between facility and external organizations.
- Initiate and complete the formal appeal process for denied admissions or continued stay.
- Assist the admissions department with pre-certifications of care.
- Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
OTHER FUNCTIONS:
- Perform other functions and tasks as assigned.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- Required Education: High school diploma or equivalent.
- Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
- Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
- CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
- First aid may be required based on state or facility requirements.
ADDITIONAL REGULATORY REQUIREMENTS:
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances
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About Acadia Healthcare
Sourced by ZipRecruiter
Acadia Healthcare is a leading provider in the healthcare and hospital industry, based in Franklin, Tennessee, United States. The company is recognised for its commitment to creating a behavioural health network that provides accessible, high-quality treatment options for individuals suffering from mental health issues, addiction, eating disorders, and PTSD. Acadia Healthcare was founded in 2005, with the mission to create a world-class organization that sets the standard of excellence in the treatment of specialty behavioural health and addiction disorders.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Franklin, TN, US
Year founded
2005