Manage insurance authorizations for clients in PHP and IOP programs, including pre-certifications and concurrent reviews.
Verify benefits, obtain Single Case Agreements, and build medical necessity cases using ASAM, LOCUS, and CALOCUS criteria.
Maintain accurate authorization, denial, and SCA records and prepare appeals on denied authorizations.
AWA and PRC are dual behavioral health organizations operating PHP and IOP programs across South Florida. They exist to serve clients and families at their most critical moments.
Conduct medical necessity reviews for inpatient admissions and post-acute services using evidence-based guidelines.
Lead peer-to-peer discussions with attending physicians to clarify clinical documentation and support appropriate care decisions.
Collaborate with utilization management and care management teams to ensure consistent, cost-effective care.
Our partner company provides utilization management services for Medicare Advantage members, focusing on evidence-based clinical decision-making. It operates with a collaborative, matrixed team and emphasizes regulatory compliance and patient-centered care.
Complete assigned medication utilization reviews and medical necessity appeals for commercial and governmental clients.
Provide peer-to-peer support to physicians and prescribers regarding clinical programs and utilization review decisions.
Actively participate in developing utilization management criteria and clinical policy revisions.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including pharmacy benefit management and health benefit management. They are rebuilding trust in healthcare in the U.S. and deploying infrastructure for better care, but no specific employee size or culture details are provided.
Assess patients through video-based encounters and perform comprehensive mental health evaluations.
Manage psychotropic medications, develop treatment plans, and collaborate with other healthcare professionals.
Maintain patient records, conduct monthly chart reviews, and stay current with continuing medical education.
Included Health is a healthcare company that delivers integrated virtual care and navigation, breaking down barriers to provide high-quality care for every person in every community. The company is on a mission to raise the standard of healthcare for everyone, offering care guidance, advocacy, and personalized virtual and in-person services.
Collaborate with experienced PMHNPs treating low- and medium-acuity patients using evidence-based approaches.
Conduct chart reviews, provide guidance on diagnoses and treatment plans, and authorize prescriptions when permitted.
Mentor clinicians and reinforce clinical standards, documentation expectations, and responsible-prescribing protocols.
Legion is a pioneering, tech-enabled psychiatry network delivering world-class outpatient care. The company prioritizes clinical quality and a collaborative culture focused on expanding access to mental health care.
Provide direct patient care as a PMHNP in a remote telehealth setting.
Conduct chart reviews and deliver empathetic feedback to improve clinical quality.
Cultivate supportive relationships with a network of psychiatric providers.
Rula is a mental health company dedicated to making mental healthcare work for everyone. They are a remote-first company with a strong focus on diversity, equity, and inclusion.
Set daily direction for your UM team, establishing priorities and reinforcing expectations.
Coach reviewers on criteria application, guiding consistent use of medical-necessity criteria.
Monitor workflow health daily, tracking intake volume and turnaround risk.
Personify Health created the first and only personalized health platform, bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together. The team is on a mission to empower people to lead healthier lives.
Conduct initial Psychiatric Diagnosis Interview Examinations and follow-up Evaluation & Management sessions via video calls.
Manage patient treatment plans and coordinate with the Talkspace psychiatry team.
Use the Talkspace platform for seamless clinical documentation and patient communication.
Talkspace is a clinical quality led Telehealth company focused on making quality behavioral health accessible and affordable. They have over two million users and foster a diverse, inclusive, and belonging-centered workplace.
Conduct initial telehealth evaluations with patients who have behavioral health and advocacy needs.
Oversee patient care plans in partnership with healthcare advocates, addressing social determinants of health.
Collaborate with the technology team to develop AI tools that enhance the clinical experience.
Baba is rebuilding healthcare for older adults by pairing them with expert advocates who coordinate care. Backed by top investors, the startup supports thousands of families and fosters a mission-driven, fast-paced culture.
Conduct comprehensive psychiatric intake evaluations and develop evidence-based treatment plans.
Collaborate with advanced practice providers and interdisciplinary teams to ensure coordinated care.
Prescribe medications through telehealth, including controlled substances, in accordance with regulations.
Legion Health is building AI infrastructure for autonomous medical care, starting with psychiatry. They are a startup with a culture of speed, ambition, and collaboration.
United States
Unlimited PTO
14w maternity
14w paternity
Provide medical review and clinical determinations based on evidence-based criteria for therapy programs.
Support clinical content team in reviewing guidelines and literature, and conduct peer-to-peer discussions with providers.
Demonstrate professionalism and accountability in a fast-paced, team-oriented environment.
Cohere Health provides a clinical intelligence platform and agentic AI-powered solutions that connect health plans and providers, optimizing care speed, cost, and quality. The company is rapidly scaling, backed by leading investors, and has been named to the Inc. 5000 list and a Top 5 LinkedIn Startup for 2023 & 2024.
Provide comprehensive mental health medication management via 60-minute intake and follow-up appointments.
Conduct psychiatric evaluations, risk assessments, and develop patient-centered treatment plans.
Collaborate with a connected network to offer accessible, culturally responsive care.
Lyra Clinical Associates partners with Lyra Health to provide evidence-based mental health care, serving over 20 million people globally. The company has delivered more than 15 million sessions of care and is known for its clinical effectiveness and cost efficiency.
Provide leadership for a behavioral health team while delivering direct clinical care with 20 hours per week of patient-facing time.
Supervise and mentor therapists to ensure quality standards, support staff development, and facilitate coordination of care.
Build strategic partnerships with pediatric practices for referrals and collaborate on recruitment and retention efforts.
Blackbird Health is a clinician-founded pediatric mental health provider delivering virtual and in-person care using a whole-child approach. They are a growing organization with a collaborative, supportive team culture focused on transforming behavioral health for youth.
Conduct comprehensive psychiatric evaluations and formulate evidence-based diagnoses.
Develop individualized treatment plans in partnership with patients and their families.
Prescribe and manage psychotropic medications, monitor effectiveness, and adjust as needed.
Backpack Healthcare provides mental health care for children, teens, and young adults via online telehealth, covered by most insurance. It is clinician-led and minority-owned, having served over 12,000 families since 2020, with a collaborative care model.
Provide excellent patient care for conditions including depression, anxiety, ADHD, insomnia, PTSD, and bipolar disorder.
Perform comprehensive psychiatric assessments and create individualized treatment plans.
Collaborate with other psychiatrists and use evidence-based protocols and responsible prescribing practices.
Legion Health is a technology-forward psychiatry company delivering world-class outpatient mental health care while expanding access for patients through insurance. Our innovative model combines the stability of a traditional hospital position with the flexibility of a private practice, prioritizing clinician well-being and professional growth.
Collaborate with care teams, maintain documentation in EHR systems, and deliver care via telehealth
Peregrine Health partners with community health organizations to expand access to behavioral health care. Their team of therapists, psychiatric nurse practitioners, and psychiatrists provide virtual care to underserved communities across the country.
Authorizes and reviews utilization of mental health and substance abuse services in inpatient and outpatient settings.
Provides telephone triage, crisis intervention, and discharge planning while collaborating with clinical teams and providers.
Analyzes utilization data, participates in quality improvement projects, and advocates for patient treatment needs.
Magellan Health is a managed care organization focused on behavioral health and substance abuse services. They are a large employer with a culture centered on caring, professional growth, and employee wellbeing.
Authorize, direct and monitor care for behavioral health and/or substance abuse problems according to clinical information.
Conduct peer reviews with psychologists, behavioral health therapists and/or Board Certified Behavior Analysts.
Interact with network practitioners to provide education on best practice models and utilization management processes.
Centene is a diversified national health insurance organization providing access to high-quality healthcare, innovative programs, and health solutions for families and individuals. They serve 28 million members and offer a collaborative, supportive team committed to clinical excellence.
Serve as collaborating physician for Tennessee-licensed PMHNPs, conducting monthly chart reviews and patient audits.
Provide 2-4 hours of direct psychiatric clinical care per week via telepsychiatry for college students.
Hold an active TN medical license as a board-certified MD/DO Psychiatrist and work autonomously in a telemedicine environment.
Mantra Health is dedicated to revolutionizing student mental health care by partnering with universities to provide universal access to high-quality mental health services for students. Since founding in 2018, they have raised over $34 million and work with students across the country, fostering a supportive culture focused on helping students stay in school.
Collaborate with experienced PMHNPs to treat psychiatry patients using evidence-based approaches.
Conduct chart reviews and provide timely guidance on diagnoses, treatment plans, and medication management.
Authorize prescriptions, including controlled substances, and mentor clinicians to uphold clinical standards.
Legion Health is a technology-forward psychiatry company delivering world-class outpatient mental health care and expanding access through insurance. They prioritize clinician well-being and professional growth, fostering a vibrant, collaborative culture with a focus on evidence-based protocols and compassionate patient care.