• Italian research (research only, no document issuance) • Research, document issuance, apostille and shipping to Brazil • Mapping

• Perform utilization and concurrent reviews of inpatient cases using Milliman, Aetna, and BCBS criteria. • Conduct medical necessity reviews for services requiring prior authorization, applying utilization-specific criteria. • Request and evaluate clinical information needed to review requested services. • Discuss cases and determinations with healthcare professionals and physician reviewers. • Identify cases requiring intervention and collaborate with Case Managers as needed. • Maintain appropriate and accurate documentation, ensuring compliance with audit standards. • Participate in team meetings, educational sessions, and related activities. • Review medical claims and pre-determinations for medical necessity and appropriateness. • Identify opportunities for process improvement and enhance communication among departments. • Consult with Physician Reviewers for complex or challenging cases.

• Perform utilization and concurrent reviews of inpatient cases using Milliman, Aetna, and BCBS criteria. • Conduct medical necessity reviews for services requiring prior authorization, applying utilization-specific criteria. • Request and evaluate clinical information needed to review requested services. • Discuss cases and determinations with healthcare professionals and physician reviewers. • Identify cases requiring intervention and collaborate with Case Managers as needed. • Maintain appropriate and accurate documentation, ensuring compliance with audit standards. • Participate in team meetings, educational sessions, and related activities. • Review medical claims and pre-determinations for medical necessity and appropriateness. • Identify opportunities for process improvement and enhance communication among departments. • Consult with Physician Reviewers for complex or challenging cases.

Role Description Are you a Psychiatric Nurse Practitioner ready to revolutionize mental healthcare from the comfort of your home? Join Valera Health, a leader at the forefront of tele-mental health, where your passion for compassionate, evidence-based care meets purpose. We are dedicated to making high-quality mental health care accessible and affordable for all. We’re currently expanding our team and looking for exceptional, driven Psychiatric Nurse Practitioners (PMHNPs) for part-time roles. The Valera Advantage: Focus on Care, Not Clutter. We believe clinicians should focus on what they do best: delivering outstanding patient care. Our collaborative model and robust technology are designed to eliminate administrative burdens, allowing you to maximize your clinical impact. What You'll Do (The Role): - Be a Clinical Leader: Provide high-quality psychiatric telehealth services, including initial assessments and follow-up appointments, adhering to APA and AACAP evidence-based guidelines. - Deliver Comprehensive Care: Masterfully diagnose, provide psychoeducation, offer supportive psychotherapy, and prescribe psychotropic medications using cutting-edge psychopharmacology. - Empower Patients: Educate patients thoroughly on the risks, benefits, and alternatives of treatment, setting reasonable outcome expectations. - Collaborate and Connect: Work seamlessly within our multidisciplinary care team (Psychiatrists, Therapists, Health Coaches) and with dedicated Health Navigators who handle patient engagement and logistics. - Maintain Clinical Excellence: Manage a caseload, swiftly check your inbox daily, respond to non-urgent clinical questions within two business days, and ensure timely documentation (notes signed within 48 hours). Qualifications - Active Psychiatric Mental Health Nurse Practitioner (PMHNP) licensure in New York - Active DEA licensure - Medicaid ID# - Minimum of two (2) years of experience as a Psychiatric Nurse Practitioner - Experience working with children and adolescents in a clinical setting Requirements - Commitment of at least 15 clinical hours per week (including supervision) - Targeting 15-28 hours a week of direct patient care - Active participation in our team-based approach with clinicians and navigators Benefits - Flexibility & Freedom: Enjoy the flexibility of working remotely with part-time or full-time hours that fit your life. - Unwavering Support: Benefit from collaborative agreements and regular clinical rounds with licensed psychiatrists, including regular supervision during your first two months. - Protected Practice: Malpractice insurance is provided by Valera. - Technology Forward: We equip you with the best EMR and technology systems to ensure efficient and effective care delivery. - Growth Opportunities: Participate in clinical training to continually refine your skills (CEUs may be available).