Behavioral Health Utilization Manager

Active BCBA (Board Certified Behavior Analyst) certification and state licensure (3+ years of ABA (Applied Behavior Analysis) clinical experience - Required Experience creating and supervising ABA (Applied Behavior Analysis) treatment plans Direct patient care background (dealing with children with Behavior / Autism issues) Utilization Management or insurance review experience strongly preferred Comfortable reviewing medical necessity and authorization requests Familiar with managed care and pay

Utilization Review Specialist (Government, RN, LPN)Introduction:Elite Technical is seeking a Maryland or Nurse Licensure Compact (NLC) certified (RN or LPN) Utilization Review Specialist to support our customer, a major Healthcare payor in the Maryland area. We are seeking candidates who have 5 years of experience as a Nurse, 2 years in a Utilization Management role, and have an understanding of Milliman Care Guidelines (MCG) and Guidingcare/Healthedge. Responsibilities:The Utilization Review Sp

Medical Director (Utilization Management) - Remote, USLocation: Remote (US) Employment Type: Contract-to-Hire Schedule: Full-time, 40 hours/week <>About the RoleWe are seeking an experienced Medical Director to join a physician-led team responsible for utilization management and clinical review activities for a health insurance organization. This role focuses on evaluating medical necessity, appropriateness of care, appeals, and complex case reviews while ensuring compliance with applicable regu

Title: Medical Director Shift timings: 8-5 EST M-F Duration: 12 months Location: The role is 100% remote, but candidates need to be from an approved conversion State (Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.) JOB DESCRIPTION The application of a Medical Dir