Top 382244 Principle Jobs

Behavioral Health Physician Reviewer
Toney HealthCare Consulting, LLC —Remote
- $175 - $200 an hour
- Part-time
- Remote
- Medicine
- Psychiatry
- Senior level
Quick Apply
Nuclear Design Engineer
Brooksource —Remote
- $60 - $80 an hour
- Contract
- Remote
- Engineering
- Research
- Mid-level
- Health savings account
- Paid holidays
Quick Apply
Pharmacy Director
AIDS Healthcare Foundation —New Orleans, LA
- Monday to Friday
- Customer service
- Mid-level
- Health insurance
Quick Apply
Team Member
Slate Auto —Warsaw, IN
- Full-time
- High school diploma or GED
- Manufacturing
- Communication skills
QA Specialist
Klosterman Baking Co —Springboro, OH
- $21 - $24 an hour
- 8 hour shift
- Microsoft Excel
- Microsoft Outlook
- High school diploma or GED
- Disability insurance
- Health insurance
Quick Apply
ROW Agent
Mesa Land Services, LLC —Remote
- $300 - $350 a day
- Full-time
- Remote
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Purchasing Manager
Munch's Supply —Remote
- Full-time
- Remote
- Background check
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- Paid holidays
Quick Apply
IRS / AC Hybrid
Sunitna River LLC —Remote
- Full-time
- Remote
- English
- Analysis skills
- Senior level
- Disability insurance
- Health insurance
Quick Apply
1099 Multi-State Licensed Medical Doctor-Initiating Patient Visits
TapestryHealth —Minneapolis, MN
- $10,000 - $25,000 a month
- Medicine
- Travel
- Reliable transportation
- Mileage reimbursement
Quick Apply
1099 Multi-State Licensed Medical Doctor-Initiating Patient Visits
TapestryHealth —Denver, CO
- $10,000 - $25,000 a month
- Medicine
- Travel
- Reliable transportation
- Mileage reimbursement
Quick Apply
Clinical Dietician PRN
Mat-Su Regional Medical Center —Palmer, AK
- Part-time
- Bachelor's degree
- Computer skills
- Communication skills
Quick Apply
Mechatronics Instructor
Johnson College —Hazle Township, PA
- Full-time
- Laboratory
- Classroom
- Word processing
- Paid jury duty
- Disability insurance
Quick Apply
Traveling Mechanic
CPKC —North Dakota
- Weekends as needed
- Background check
- 18 years or older
- 5 years
- Opportunities for advancement
Experienced CAD/CAM Technician
PDL Laboratory, Inc. —Plymouth, MA
- Full-time
- Anatomy knowledge
- Software troubleshooting
- 5 years
- Health insurance
- 401(k)
Quick Apply
Physician Assistant
Center for Neurosciences —Tucson, AZ
- Full-time
- CPR Certification
- Writing skills
- BLS Certification
Quick Apply
Pharmacist
AmPharm —Parsons, TN
- Full-time
- HIPAA
- Mid-level
- 3 years
- Paid training
- Continuing education credits
Quick Apply
Clinical Pharmacist
CaroMont Health —Gastonia, NC
- Part-time
- Mid-level
- Medical terminology
- Communication skills
- Health insurance
- Dental insurance
Environmental Specialist
Smyrna Ready Mix, LLC —Springfield, OH
- Full-time
- Pass drug screening
- Mid-level
- Master's degree
- Paid holidays
- Disability insurance
Program Manager - Cardiac Rehabilitation
SouthEast Alaska Regional Health Consortium —Juneau, AK
- $36.46 - $51.29 an hour
- Full-time
- Microsoft Excel
- Computer literacy
- BLS Certification
- Paid parental leave
- Disability insurance
Quick Apply
Float Pharmacist
Sterling Pharmacy —La Crescent, MN
- $55 - $65 an hour
- 8 hour shift
- CPR Certification
- BLS Certification
- Mid-level
- Store discount
- Health savings account
Quick Apply

I want to receive the latest job alert for Principle

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

Principle jobs near

Behavioral Health Physician Reviewer

Toney HealthCare Consulting, LLC -
Remote

Quick Apply

Job Details

Part-time | Contract
$175 - $200 an hour

Qualifications

Medicare
Psychiatry
Regulatory compliance
Utilization management
Clinical information systems
Quality improvement
Clinical documentation
Resource utilization in healthcare
Medical License
Working with individuals with mental health conditions
Time management

Full Job Description

Position Summary:

The Behavioral Health Physician UM Reviewer is responsible for conducting clinical reviews of behavioral health services to ensure medical necessity, appropriateness of care, and compliance with regulatory standards. This role collaborates closely with care management teams, providers, and payers to support effective utilization of behavioral health services and to promote high-quality, cost-effective treatment for members.

Key Responsibilities:

Review and evaluate behavioral health service requests for medical necessity based on evidence-based criteria (e.g., MCG, InterQual, ASAM).
Collaborate with clinical and non-clinical team members to support integrated care management.
Make determinations on service authorizations, denials, or the need for peer-to-peer discussions in alignment with organizational policies.
Participate in case conferences and interdepartmental rounds to support ongoing utilization management initiatives.
Ensure compliance with NCQA, URAC, CMS, and state/federal guidelines.
Provide clinical guidance and feedback to utilization review staff and care coordination teams.
Maintain documentation of all reviews and decisions in appropriate systems within required timeframes.
Support quality improvement initiatives and clinical policy development as needed.
Participate in audits and appeal processes related to utilization of review decisions.

Qualifications:

MD or DO with current, unrestricted license to practice medicine.
Board certification in Psychiatry or Child and Adolescent Psychiatry (required).
Minimum 5 years of clinical experience in behavioral health settings.
At least 2 years of experience in utilization management, care review, or health plan operations (preferred).
Familiarity with utilization review criteria, regulatory standards, and managed care principles.
Strong decision-making, analytical, and interpersonal communication skills.
Proficiency in EMR and UM platforms (e.g., Jiva or similar systems).

Preferred Skills:

Experience with Medicaid, Medicare, or commercial insurance utilization review.
Knowledge of behavioral health treatment modalities including inpatient, outpatient, and substance use care.
Ability to work independently and as part of a multidisciplinary team.
Strong organizational and time management abilities.

Pay: $175.00 - $200.00 per hour

Experience:

Utilization Management: 2 years (Required)
clinical behavioral health : 5 years (Required)

License/Certification:

board certification in psychiatry or adolescent psychiatry (Required)
Medical License (Required)

Work Location: Remote

Quick Apply

Refine Your Search

Principle jobs

Behavioral Health Physician Reviewer

Nuclear Design Engineer

Pharmacy Director

Team Member

QA Specialist

ROW Agent

Purchasing Manager

IRS / AC Hybrid

1099 Multi-State Licensed Medical Doctor-Initiating Patient Visits

1099 Multi-State Licensed Medical Doctor-Initiating Patient Visits

Clinical Dietician PRN

Mechatronics Instructor

Traveling Mechanic

Experienced CAD/CAM Technician

Physician Assistant

Pharmacist

Clinical Pharmacist

Environmental Specialist

Program Manager - Cardiac Rehabilitation

Float Pharmacist

I want to receive the latest job alert for Principle

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected