RN, Behavioral Health

HealthEdge

. Provide telephonic coordination and delivery of clinical behavioral health services .

Posted 10/8/2026full-timeRemote • United StatesJuniorMid-Level💰 $65,000 - $85,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical behavioral health services coordination, utilization management, and case management, with a strong focus on regulatory compliance and effective communication with healthcare providers.

Highest-signal resume keywords

Registered Nurse LicenseBehavioral Health Clinical ExperienceUtilization Management ExperienceCase Management CertificationMedical Necessity Assessment

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Behavioral Health ServicesUtilization ManagementMedical Necessity AssessmentDischarge PlanningDocumentation PreparationPatient ManagementRegulatory ComplianceAlternative Treatment RecommendationsBenefit CoordinationHealthcare Service Utilization

Soft Skills

Excellent Communication SkillsCustomer Service SkillsInterpersonal Skills

Tools & Technologies

Microsoft Office Suite

Certifications & Qualifications

Registered Nurse LicenseCase Management Certification

Industry Keywords

Acute Clinical ExperienceManaged CareHealth Insurance Plan ExperienceAccreditation StandardsCommunity Resources

About the role

Key responsibilities & impact

Provide telephonic coordination and delivery of clinical behavioral health services
Perform prospective, concurrent and retrospective reviews of inpatient, outpatient, ambulatory and ancillary services
Assess medical necessity, appropriate length of stay, intensity of service and level of care
Review, research and authorize elective, direct, ancillary, urgent and emergency service requests
Identify and recommend alternative treatments, service levels and lengths of stay using approved clinical protocols
Analyze and prepare documentation for retrospective reviews and appeals in accordance with regulatory and accreditation standards
Establish, coordinate and communicate discharge planning needs
Research and resolve benefit, eligibility, non-authorized service, coordination-of-benefits and care coordination issues
Develop and deliver targeted education for providers
Communicate with providers and other parties to facilitate care and treatment
Identify referral opportunities and promote quality and effective healthcare service and benefit utilization
Consult with internal and external constituents on utilization and benefit management
Coordinate, document and communicate all aspects of the utilization/benefit management program

Requirements

What you’ll need

Current unrestricted Registered Nurse license required
2+ years of acute clinical experience as RN required
1+ years Behavioral Health clinical experience
1+ years Managed Care or Utilization Management experience
One year health insurance plan experience or managed care environment preferred
Certification in Case Management may be preferred based upon designated department assignment
Certification or progress toward certification is highly preferred and encouraged
Excellent written and verbal communication skills
Excellent customer service and interpersonal skills
Working knowledge of Microsoft Office Suite PC applications
Ability to apply clinical criteria/guidelines for medical necessity, setting/level of care and concurrent patient management
Knowledge of standard medical procedures/practices, current trends in medicine and nursing, alternative care settings and levels of service
Knowledge of policies and procedures, member benefits and community resources
Knowledge of applicable accreditation standards and local, state and federal regulations
Candidates may be required to complete a pre-employment criminal background check

Benefits

Comp & perks

Full-time, permanent employment
Remote work environment
May require travel dependent on company needs
Reasonable accommodations for individuals with disabilities
Equal opportunity employer committed to workforce diversity