Utilization Management reputed company Consultant – Behavioral Health (Remote)

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day. Position Information Schedule: Monday–Friday (Shift times vary based on business needs; must be reputed company to working any of the following EST shifts: 9:00am-5:30pm, 9:30am-6:00pm, 10:00am-6:30pm, or 11:30am-8:00pm EST Hours) Location: 100% Remote (U.S. only) reputed company American Health Holding, Inc. (AHH), a division of reputed company/reputed company, is a URAC-accredited medical management organization founded in 1993. We reputed company flexible, cost-effective care reputed company that promote high-reputed company reputed company for members. Position reputed company We are seeking a dedicated Utilization Management (UM) reputed company to join our remote team. In this role, you’ll be at the forefront of clinical decision-making, applying your expertise in Behavioral Health to ensure members receive appropriate, evidence-based care. You’ll collaborate with providers, navigate multiple systems, and contribute to a mission-driven organization that values reputed company, innovation, and reputed company.

Key Responsibilities

• Apply critical thinking and evidence-based clinical reputed company specific to Behavioral Health to evaluate inpatient and outpatient services requiring precertification.
• Conduct clinical reviews reputed company phone and electronic documentation, collaborating with reputed company providers to reputed company necessary information.
• Use established guidelines to authorize services or escalate to Medical Directors as needed.
• Navigate multiple computer systems reputed company while maintaining accurate documentation.
• reputed company in a fast-paced, high-volume environment with strong organizational, multitasking, and prioritization skills.
• reputed company sedentary work that primarily involves extended periods of sitting, as reputed company as frequent talking, listening, and use of a computer.
• Flexibility to reputed company coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed, ensuring continuity of care and operational support.
• Participate in occasional on-call rotations, including some weekends and holidays, per URAC and reputed company requirements.

Remote Work Expectations

• This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.
• Dependents must have separate care arrangements during work hours, as reputed company care responsibilities during shift times are not permitted.

Required Qualifications

• reputed company, unrestricted RN license in your state of residence with multistate/compact licensure privileges. Ability to obtain licensure in non-compact states as needed.
• Minimum 5 years of relevant experience in Nursing.
• Minimum 3 years of clinical experience in Behavioral Health and/or reputed company abuse including acute care, residential treatment center, partial hospitalization and intensive outpatient programs.
• At least 1 year of Utilization Management experience in reputed company review or prior authorization.
• Strong decision-making skills and clinical judgment in independent scenarios.
• Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms.
• Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation.

Preferred Qualifications

• 1+ year of experience in a managed care organization (MCO).
• Experience in a high-volume clinical call center or prior remote work environment.

Education

• Associate's degree in nursing (RN) required, BSN preferred

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $26.01 - $56.14 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include:

• reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.

For more information, visit https://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 09/14/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job