What are the responsibilities and job description for the Utilization Management Nurse – Behavioral Health Focus (Remote) position at Morgan Stephens?
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:
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Review provider submissions for prior service authorizations, particularly in behavioral health
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Evaluate requests for medical necessity and appropriate service levels
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Provide concurrent review and prior authorization according to internal policies
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Identify appropriate benefits and determine eligibility and expected length of stay
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Collaborate with internal departments, including Behavioral Health and Long Term Care, to ensure continuity of care
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Refer cases to medical directors as needed
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Maintain productivity and quality standards
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Participate in staff meetings and assist with onboarding of new team members
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Foster professional relationships with internal teams and provider partners
Must-Have Requirements:
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Background in Behavioral Health services and/or experience with a Managed Care Organization (MCO) in Utilization Management
Licensure Requirements:
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Active, unrestricted RN, LPN, LCSW, or LPC license
Required Education and Experience:
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Completion of an accredited Registered Nursing program (or equivalent combination of experience and education)
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2 years of clinical experience, preferably in hospital nursing, utilization management, or case management
Knowledge, Skills, and Abilities:
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Understanding of state and federal healthcare regulations
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Experience with InterQual and NCQA standards
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Strong organizational, communication, and problem-solving skills
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Proficient in Microsoft Office and electronic documentation systems
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Ability to work independently and manage multiple priorities
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Professional demeanor and commitment to confidentiality and compliance with HIPAA standards
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Team-oriented with the ability to build and maintain positive working relationships
Salary : $40