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Job Requirements of RN Utilization Review Nurse (Behavioral Health):
-
Employment Type:
Contractor
-
Location:
Las Vegas, NV (Onsite)
Do you meet the requirements for this job?
RN Utilization Review Nurse (Behavioral Health)
Careers Integrated Resources Inc
Las Vegas, NV (Onsite)
Contractor
Job Title: RN Utilization Review Nurse (Behavioral Health)
Location: 100% Remote
Duration: 3 Months (Potential for Extension)
Pay Rate: $43.06/hr. (W2)
Schedule: Monday–Friday, 5:00 AM–2:00 PM PST or 2:00 PM–11:00 PM PST
Position Overview:
- We are seeking an experienced Registered Nurse (RN) to join the Utilization Management (UM) team supporting behavioral health services. The RN will perform utilization reviews, prior authorizations, and ensure members receive the right care at the right time in compliance with state and federal regulations.
- This position requires a strong background in Utilization Management, MCG/ASAM, and Behavioral Health populations.
Key Responsibilities:
- Perform concurrent reviews and prior authorizations in accordance with company policies and UM protocols.
- Assess member eligibility, benefits, and appropriate levels of care.
- Identify and authorize services based on medical necessity and expected length of stay.
- Collaborate with interdisciplinary teams, including Behavioral Health and Long-Term Care, to ensure coordinated member care.
- Maintain departmental productivity and quality standards.
- Participate in staff meetings, training, and mentoring of new team members.
- Communicate and consult regularly with medical directors for complex case reviews.
- Maintain accurate and confidential member documentation in compliance with HIPAA.
Qualifications:
- Education: Completion of an accredited Registered Nursing program (or equivalent experience and education).
- Licensure/Certification: Active, unrestricted Nevada RN license (or ability to obtain one upon starting). ASAM certification required within 30 days of assignment.
- Experience: Minimum 2 years of Utilization Management experience required. Experience with MCG guidelines and prior authorizations for behavioral health strongly preferred.
Skills & Competencies:
- Strong clinical assessment, critical thinking, and problem-solving abilities.
- Excellent communication and interpersonal skills.
- Proficiency with Microsoft Office and clinical documentation systems.
- Knowledge of MCG, InterQual, ASAM, and NCQA standards.
- Ability to manage multiple priorities in a fast-paced remote environment.
- Exceptional organizational skills and attention to detail.
- Commitment to maintaining confidentiality and upholding professional ethics.
Why Join Us:
- 100% remote work with flexible scheduling options.
- Opportunity to work with a leading managed care organization.
- Supportive team culture with ongoing training and development.
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