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Behavioral Utilization Review Jobs in Missouri (NOW HIRING)

Arch Vista

UR Coordinator

Saint Louis, MO · On-site

$15 - $22/hr

Arch Vista is seeking a detail-oriented and organized Utilization Review (UR) Coordinator to ... Experience in a hospital, health plan, behavioral health, post-acute care, or other healthcare ...

UHS

UR COORDINATOR

Nevada, MO · On-site

... utilization review. · Strong working knowledge of insurance verification, medical necessity ... Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory ...

UHS

UR COORDINATOR

Nevada, MO · On-site

... and/or utilization review. • Strong working knowledge of insurance verification, medical ... Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory ...

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Behavioral Utilization Review information

What is the difference between Behavioral Utilization Review vs Behavioral Case Manager?

AspectBehavioral Utilization ReviewBehavioral Case Manager
CredentialsLicensed mental health professionals, certifications varyLicensed clinical social workers, counselors, or therapists
Work EnvironmentReview settings, insurance companies, healthcare facilitiesDirect patient interaction, hospitals, outpatient clinics
Employer & IndustryInsurance companies, healthcare organizationsHospitals, mental health agencies, managed care
Primary FocusAssessing medical necessity, reviewing treatment plansCoordinating 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 Missouri?

For Behavioral Utilization Review jobs in Missouri, the most frequently searched job titles are:

What job categories do people searching Behavioral Utilization Review jobs in Missouri look for?

The top searched job categories for Behavioral Utilization Review jobs in Missouri are:

What cities in Missouri are hiring for Behavioral Utilization Review jobs?

Cities in Missouri with the most Behavioral Utilization Review job openings:

Behavioral Utilization Review jobs near you

Utilization Management Professional

Saviance

Saint Louis, MO • On-site

Other

Re-posted 17 days ago

Job description

Job Title

Reviews planned, in process, or completed health care services to ensure medical necessity and effectiveness according to evidence-based criteria. Proposes alternatives when the requested services do not meet medical necessity criteria or are outside the contracted network. As assigned and based on credentials, monitors and reviews specialized requests and treatment records such as Treatment Record Forms. Provides information to enrollees, providers, and internal staff regarding covered and non-covered benefits, community resources, agency programs and policies, procedures and criteria. Develops and manages new enrollee transitions and those involving a change in provider relationships. Develops and implements transition plans, as indicated, to ensure continuity of care. Negotiates and documents single case agreements according to procedures. In conjunction with providers and facilities, identifies, develops and monitors discharge plans. Collaborates with the Care Coordination team to implement support for transitions in care. Facilitates timely sharing of enrollees' clinical information (such as previous treatment, medications, and planned care) in order to promote continuity of care. Interacts with Medical Directors and Physician Advisors to provide case information and discuss clinical and authorization questions and concerns regarding specific cases. Assures that case documentation for each decision is complete, including related correspondence. Participates in Care Coordination team and utilization management activities, including collaboration with other staff on enrollee cases, and performing data collection, tracking, and analysis.

Maintains an active work load in accordance with performance standards. Works with community agencies as appropriate.

Participates in network development including identification and recruitment of quality providers as needed. Advocates for the enrollee to ensure health care needs are met. Interacts with providers in a professional, respectful manner.

Provides coverage of Nurse Line and/or Crisis Line as requested or required for position.

Associates - Nursing Bachelors - Nursing Bachelors - Social Work Social Work Masters - Social Work LPN LCSW - Licensed Clinical Social Worker LMHP - Licensed Mental Health Professional LPC - Licensed Professional Counselor LMFT - Licensed Marital and Family Therapist LISAC - Licensed Independent Substance Abuse Counselor certification. RN or clinical credentials in a behavioral health field.

If nurse, RN license at a minimum. If not an RN, must hold Masters or Doctoral Degree.

If other than RN, Masters level licensed behavioral health professional. Good organization, time management and verbal and written communication skills. Knowledge of utilization management procedures, Medicaid benefits, community resources and providers. Knowledge and experience in diverse patient care settings including inpatient care. Ability to function independently and as a team member. Knowledge of ICD and DSM IV coding or most current edition. Ability to analyze specific utilization problems and creatively plan and implement solutions.

5-7 years' experience post degree in a clinical, psychiatric and/or substance abuse health care setting.

Minimum of 5 years of experience conducting utilization management according to medical necessity criteria required.

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About Saviance

Sourced by ZipRecruiter

Saviance is a modern consulting firm providing a variety of professional services to its clients in the US. We bring twenty three years of experience to the table. Our consultants are qualified experts and extremely talented. We understand the business behind the technology, and work with many of the top Fortune 100 companies and provide innovative, scalable, robust and secure solutions. At the forefront of the Staffing and IT Solutions industry, Saviance is certified by NMSDC as a Tier 1, Minority Business Enterprise (MBE) . We are a self- certified Small Business and self- certified Woman Owned Business committed to maximizing global workforce solutions on behalf of our clients, empowering businesses and talent through applied human intelligence. We are a Diversity Supplier with global reach specializing in a business services blend of talent, technology, and a relentless commitment to customer success. It’s our diversity that’s acts as a core component of our culture, our approach to business, and the opportunities we provide to our clients and our employees.

Industry

It services

Company size

201 - 500 Employees

Headquarters location

East Rutherford, NJ, US

Year founded

1999

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