Top 137 Utilization review Jobs in Missouri

Utilization Review Clinician - Behavioral Health
Centene —Missouri
- $27.02 - $48.55 an hour
- Full-time
- Remote
- LMFT
- Nursing
- Addiction Medicine
- Paid holidays
- Health insurance
5d
Utilization Management Registered Nurse
Humana —Missouri
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
Appeals Nurse Consultant
CVS Health —Missouri
- $54,095 - $142,576 a year
- Weekends as needed
- Remote
- Nursing
- RN License
- Research
- Health insurance
- Dental insurance
4d
Utilization Reviewer 2
Enlyte —St. Louis, MO
- $52,750 - $76,000 a year
- Full-time
- RN License
- Mid-level
- Office
- Health savings account
- AD&D insurance
13d
Psychiatrist and Medical Director
Confidential —Missouri
- Full-time
- Background check
- Medicine
- Psychiatry
- Health insurance
- Dental insurance
Quick Apply
Case Manager
Valley Springs Youth Ranch —Black, MO
- From $20 an hour
- Full-time
- Mid-level
- Residential
- Experience working with children
- Paid training
- Health savings account
Quick Apply
Group Therapist
KVC Health Systems —St. Louis, MO
- Full-time
- LMFT
- Licensed Clinical Social Worker
- Mid-level
Quick Apply
RN Clinical Nurse Manager Med-Surg (Charge)
TribalEM —Kansas City, MO
- $36.65 - $47.64 an hour
- Full-time
- Nursing
- Patient monitoring
- RN License
- Health savings account
- Employee stock purchase plan
Quick Apply
MDS Coordinator (RN) *Sign-On Bonus!*
St. Sophia Health & Rehabilitation Center —Florissant, MO
- Full-time
- CPR Certification
- Nursing
- Skilled nursing facility
- Dental insurance
- 401(k)
Quick Apply
MDS Coordinator (LPN or RN)
Ozark Care & Rehab Center —Ozark, MO
- Full-time
- CPR Certification
- Nursing
- Skilled nursing facility
- Dental insurance
- 401(k)
Quick Apply
MDS Coordinator (LPN or RN) *$10,000 Sign-on Bonus*
Woodland Care & Rehab Center —Springfield, MO
- Full-time
- CPR Certification
- Nursing
- Skilled nursing facility
- Dental insurance
- 401(k)
Quick Apply
Medical Office Supervisor
Kansas City Urology Care —Independence, MO
- Full-time
- Private practice
- Mid-level
- Team management
- Health insurance
- Dental insurance
Quick Apply
6d
Pharmacy Second Level Review Contractor
Wipro Limited —Jefferson City, MO
- $90 - $95 an hour
- Contract
- Nursing
- RN License
- Pass drug screening
- Disability insurance
- Health insurance
Utilization Review RN
Western Missouri Medical Center —Warrensburg, MO
- Full-time
- RN License
- HIPAA
- Mid-level
Quick Apply
13d
Authorization and Appeals Specialist
BioTAB Healthcare —St. Louis, MO
- $22 an hour
- Full-time
- Background check
- HIPAA
- Research
UR Coordinator
Arch Vista —St. Louis, MO
- $15 - $22 an hour
- Psychiatry
- Adults
- HIPAA
- Paid holidays
- Disability insurance
Quick Apply
Registered Nurse - Clinical Documentation Improvement Advisor
US Veterans Health Administration —St. Louis, MO
- $75,487 - $153,842 a year
- Online Application
- Background check
- Nursing
- Doctoral degree
- Paid holidays
- Dental insurance
4d
Manager Registered Nurse - Utilization Management
SSM Health —Missouri
- Weekends as needed
- Nursing
- RN License
- Bachelor's degree
- Paid parental leave
- Health insurance
Utilization Review (LPN or RN)
Hannibal Regional Healthcare System —Hannibal, MO
- Part-time
- Nursing
- RN License
- Computer literacy
7d
Senior Director Credentialing & Contracting (Hybrid) - Faculty Practice Plan
Washington University in St. Louis —St. Louis, MO
- $129,800 - $228,400 a year
- Online Application
- Hybrid work
- Word processing
- Writing skills
- Pass drug screening
- Commuter assistance
- Employee assistance program

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utilization review jobs near missouri

Utilization Review Clinician - Behavioral Health

Centene -
Missouri

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Job Details

Full-time
$27.02 - $48.55 an hour
5 days ago

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Master's degree

Full Job Description

Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate.

Key Details: Applicants for this role have the flexibility to work remotely from their home anywhere in the Central Time Zone. The work schedule is Monday - Friday, 8am - 5pm with an occasional weekend or holiday required.

Evaluates member’s treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate
Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria
Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning
Analyzes BH member data to improve quality and appropriate utilization of services
Provides education to providers members and their families regrading BH utilization process
Interacts with BH healthcare providers as appropriate to discuss level of care and/or services
Engages with medical directors and leadership to improve the quality and efficiency of care
Formulates and presents cases in staffing and integrated rounds
Performs other duties as assigned.
Complies with all policies and standards.

Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience.

License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.
Master’s degree for behavioral health clinicians required.
Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred.
Knowledge of mental health and substance abuse utilization review process preferred.
Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred.

License/Certification:

LCSW- License Clinical Social Worker required or
LMHC-Licensed Mental Health Counselor required or
LPC-Licensed Professional Counselor required or
Licensed Marital and Family Therapist (LMFT) required or
Licensed Mental Health Professional (LMHP) required or
RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Pay Range: $27.02 - $48.55 per hour

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Apply Now

Refine Your Search

utilization review jobs in missouri

Utilization Review Clinician - Behavioral Health

Utilization Management Registered Nurse

Appeals Nurse Consultant

Utilization Reviewer 2

Psychiatrist and Medical Director

Case Manager

Group Therapist

RN Clinical Nurse Manager Med-Surg (Charge)

MDS Coordinator (RN) Sign-On Bonus!

MDS Coordinator (LPN or RN)

MDS Coordinator (LPN or RN) $10,000 Sign-on Bonus

Medical Office Supervisor

Pharmacy Second Level Review Contractor

Utilization Review RN

Authorization and Appeals Specialist

UR Coordinator

Registered Nurse - Clinical Documentation Improvement Advisor

Manager Registered Nurse - Utilization Management

Utilization Review (LPN or RN)

Senior Director Credentialing & Contracting (Hybrid) - Faculty Practice Plan

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