Reviews behavioral health cases to determine medical necessity and appropriateness of care ... Conducts utilization reviews of behavioral health cases to determine medical necessity ...
Reviews behavioral health cases to determine medical necessity and appropriateness of care ... Conducts utilization reviews of behavioral health cases to determine medical necessity ...
Reviews behavioral health cases to determine medical necessity and appropriateness of care ... Conducts utilization reviews of behavioral health cases to determine medical necessity ...
Reviews behavioral health cases to determine medical necessity and appropriateness of care ... Conducts utilization reviews of behavioral health cases to determine medical necessity ...
As a national leader in behavioral healthcare, NPH specializes in caring for patients with acute ... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ...
As a national leader in behavioral healthcare, NPH specializes in caring for patients with acute ... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ...
As a national leader in behavioral healthcare, NPH specializes in caring for patients with acute ... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ...
As a national leader in behavioral healthcare, NPH specializes in caring for patients with acute ... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ...
As a national leader in behavioral healthcare, NPH specializes in caring for patients with acute ... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ...
As a national leader in behavioral healthcare, NPH specializes in caring for patients with acute ... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ...
Utilization Review Specialist Unique opportunity to join Maryhaven, Central Ohio's largest and most comprehensive behavioral services provider specializing in addiction recovery. We are looking for ...
New
Utilization Review Specialist Unique opportunity to join Maryhaven, Central Ohio's largest and most comprehensive behavioral services provider specializing in addiction recovery. We are looking for ...
New
UR Coordinator
Cincinnati, OH · On-site
$18 - $22/hr
Utilization Review (UR) Coordinator Schedule: Full Time Location: Blue Ash, OH Compensation: $18 - $22 hr Position Summary Leora Behavioral Health is seeking a detail-oriented and organized ...
New
UR Coordinator
Cincinnati, OH · On-site
$18 - $22/hr
Utilization Review (UR) Coordinator Schedule: Full Time Location: Blue Ash, OH Compensation: $18 - $22 hr Position Summary Leora Behavioral Health is seeking a detail-oriented and organized ...
New
UR Coordinator, Full Time
$24 - $32/hr
... behavioral health treatment center. About the Role RiverVista is seeking a detail-oriented and knowledgeable Utilization Review (UR) Coordinator to support clinical documentation, insurance ...
UR Coordinator, Full Time
$24 - $32/hr
... behavioral health treatment center. About the Role RiverVista is seeking a detail-oriented and knowledgeable Utilization Review (UR) Coordinator to support clinical documentation, insurance ...
Monitors and reviews MCO portals to track authorization status, pending requests, approvals ... Strong understanding of behavioral health authorization processes and payer requirements.
Monitors and reviews MCO portals to track authorization status, pending requests, approvals ... Strong understanding of behavioral health authorization processes and payer requirements.
UM Coordinator
Cincinnati, OH · On-site
$18 - $24/hr
Position Summary The Utilization Management (UM) Coordinator supports the facility's utilization review and authorization processes for patients receiving mental health and behavioral health services.
UM Coordinator
Cincinnati, OH · On-site
$18 - $24/hr
Position Summary The Utilization Management (UM) Coordinator supports the facility's utilization review and authorization processes for patients receiving mental health and behavioral health services.
The Transplant Nurse, Utilization Review provides the highest level of clinical service both ... Maintain contact with internal clinical staff for transfer of cases for behavioral health ...
The Transplant Nurse, Utilization Review provides the highest level of clinical service both ... Maintain contact with internal clinical staff for transfer of cases for behavioral health ...
The Transplant Nurse, Utilization Review provides the highest level of clinical service both ... Maintain contact with internal clinical staff for transfer of cases for behavioral health ...
The Transplant Nurse, Utilization Review provides the highest level of clinical service both ... Maintain contact with internal clinical staff for transfer of cases for behavioral health ...
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 ...
Utilization Management Rep I
Mason, OH · On-site
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 ...
Utilization Management Rep I
Mason, OH · On-site
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 ...
Utilization Management Rep I
Mason, OH · On-site
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 ...
Utilization Management Rep I
Mason, OH · On-site
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 ...
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 Ohio?
For Behavioral Utilization Review jobs in Ohio, the most frequently searched job titles are:
- Utilization Review Social Worker
- Remote Utilization Review Social Worker
- Utilization Review Physician
- Manager Utilization Management
- Evening Utilization Review Nurse
- Full Time Remote Utilization Review
- Night Utilization Review Nurse
- Home Based Utilization Review Nurse
- Remote Utilization Review Rn
- Remote Utilization Management
What job categories do people searching Behavioral Utilization Review jobs in Ohio look for?
The top searched job categories for Behavioral Utilization Review jobs in Ohio are:
- Dental Utilization Review
- Remote Aetna Utilization Review Nurse
- Remote Optum Utilization Review
- Remote Navihealth Utilization Review
- Utilization Review Clinician Salary
- Pt Ot Utilization Review
- Medical Utilization Review Physician
- Utilization Review Nurse Compact License
- Utilization Review Coordinator
- Work From Home Utilization Review
What cities in Ohio are hiring for Behavioral Utilization Review jobs?
Cities in Ohio with the most Behavioral Utilization Review job openings:
Full-time
Re-posted 10 days ago
Nationwide Children's Hospital rating
6.9
Based on 131 frontline employees who took The Breakroom Quiz
551st of 1,064 rated hospitals
Job description
Overview:
Schedule: Monday-Friday (8:00am-4:30pm)
Position is work from home after a 90 day in-office training period.
Job Description Summary:
Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies. Performs pre-certifications, pre-authorizations, re-authorization, concurrent utilization reviews, retrospective reviews, and denial management. Interacts with staff and departments of the hospital to facilitate appropriate, cost-effective patient care.
Job Description:
Essential Functions:
Education Requirement:
Bachelor's Degree in Social Work, Psychology, or related field, required.
Licensure Requirement:
(not specified)
Certifications:
(not specified)
Skills:
Experience:
Physical Requirements:
OCCASIONALLY: Bend/twist, Climb stairs/ladder, Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Reaching above shoulder, Squat/kneel
FREQUENTLY: Standing, Walking
CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing - Far/near, Sitting
Additional Physical Requirements performed but not listed above:
(not specified)
"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
Schedule: Monday-Friday (8:00am-4:30pm)
Position is work from home after a 90 day in-office training period.
Job Description Summary:
Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies. Performs pre-certifications, pre-authorizations, re-authorization, concurrent utilization reviews, retrospective reviews, and denial management. Interacts with staff and departments of the hospital to facilitate appropriate, cost-effective patient care.
Job Description:
Essential Functions:
- Conducts utilization reviews of behavioral health cases to determine medical necessity, appropriateness of care, and adherence to clinical guidelines.
- Communicates with healthcare teams and third-party payors to ensure the delivery of quality care and optimum payment.
- Assists with retrospective reviews and denial management to maintain appropriate and cost-effective patient care.
- Documents all case reviews and maintains accurate records of all clinical activities and coverage information.
- Provides education and support regarding utilization review and management activities and processes.
- Analyzes clinical data to identify trends and patterns that may impact patient care. Participates in quality improvement initiatives to enhance the overall delivery of behavioral health services.
- Facilitates reimbursement by communicating with payers, other staff, patients, and families concerning status of funding and required actions.
Education Requirement:
Bachelor's Degree in Social Work, Psychology, or related field, required.
Licensure Requirement:
(not specified)
Certifications:
(not specified)
Skills:
- Excellent written and verbal communication and interpersonal skills.
- Excellent customer service and organizational skills.
- Working knowledge of CMS and other review agency standards.
- Proficient with software applications including CM, payer web applications, MITS, and others.
Experience:
- Three years of behavioral health experience, required.
- One year of experience in pediatric care or services, required.
- Utilization review or utilization management experience, preferred.
Physical Requirements:
OCCASIONALLY: Bend/twist, Climb stairs/ladder, Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Reaching above shoulder, Squat/kneel
FREQUENTLY: Standing, Walking
CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing - Far/near, Sitting
Additional Physical Requirements performed but not listed above:
(not specified)
"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
What Nationwide Children's Hospital employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Nationwide Children's Hospital
Sourced by ZipRecruiter
Nationwide Children's Hospital, established in 1894, is a leading pediatric healthcare system based in Columbus, Ohio, United States. They serve as a primary pediatric network, providing wellness, preventive, diagnostic, treatment, and rehabilitative care for infants, children, adolescents, and adults with congenital disease. Being the third-largest pediatric hospital in the nation, Nationwide Children's Hospital prides itself on its relentless commitment to children and their families, driven by their core values of respect, integrity, determination, empathy, and solidarity. The institution's comprehensive mission is to enhance the health of children by providing high-quality, family-centered care, conducting groundbreaking research, advocating for pediatric health, and training top healthcare professionals.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Columbus, OH, US
Year founded
1892