This page tracks remote clinician openings that are location-eligible for Nebraska.
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$27 - $73,000
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14 Jobs
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• The Clinician, CCR delivers behavioral health utilization management by conducting clinical reviews, coordinating care, and partnering with providers and internal teams to ensure medically appropriate treatment, effective discharge planning, and positive member outcomes • Conduct clinical reviews across all levels of behavioral health care and apply medical necessity criteria to treatment decisions • Utilize clinical judgment, evidence-based practices, and peer review processes to recommend appropriate levels of care • Collaborate with members, families, providers, and internal teams to coordinate care and ensure access to appropriate services and resources • Support discharge planning and continuity of care, including referrals, follow-ups, and connection to community or outpatient services • Maintain accurate clinical documentation and adhere to health plan requirements, regulatory standards, and utilization management processes • Contribute to quality outcomes by managing caseloads, participating in clinical rounds, and supporting efficient service delivery within established guidelines
Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives.
Role Description Trillium Health Resources has a career opening for a MH/SU UM Clinician to join our team! The MH/SU UM Clinician is responsible for providing comprehensive clinical review of services requests for people who experience psychiatric symptoms related to mental health issues and/or co-occurring or co-morbid conditions or symptoms or addictions to substances and/or developmental disabilities. On a typical day, you might: - Provide clinical review of services for members or enrollees with mental health, substance use, and/or developmental disabilities including diagnosis review, medical necessity criteria, determining member eligibility; level of care needed and making service authorization decisions regarding individual service authorizations with timely, clear, concise documentation. - Provide clinical triage for members seeking services through Screening, Triage and Referral. - Provide consultation and technical assistance to providers regarding clinical care needs, levels of care, Client Rights Rules, evidenced based practices, scope of practice issues etc. - Provide ongoing review/staffing/consultation of treatment documentation of needs for members participating in group, family or individual services. Qualifications - Master’s degree in a Human Services field and a minimum of (1) year of progressive experience providing care management, case management, care coordination and/or assessing and/or evaluating the support needs of the BH/MH/SU/IDD population. - Active valid license in the state of North Carolina as an LCSW, LCMHC, LCAS, LPA, LP or LMFT. - Must have a valid driver’s license. - Must reside within North Carolina. - Must be able to travel within catchment as required. Requirements - A minimum of two (2) years post-Master’s experience in a clinical setting with the BH/MH/SU/IDD population. Benefits - Typical working hours: 8:30 am – 5:00 pm; flexible work schedules with some roles with management approval. - Work-from-home options available for most positions. - Health Insurance with no premium for employee coverage. - Flexible Spending Accounts. - 24 days of Paid Time Off (PTO) plus 12 paid holidays in your first year. - NC Local Government Retirement Pension (defined-benefit plan). - 401k with 5% employer match and immediate vesting. - Public Service Loan Forgiveness (PSLF) qualifying employer. - Quarterly stipend for remote work supplies. How to Apply To be considered, submit your application and resume through our ADP Career Center. Your resume must include: - Employer name, dates of service (month/year), average hours worked per week, and essential job duties. - Education details (degree type, date awarded, institution, field of study). - Licensure/certification information, if applicable. After submission, your resume will be reviewed to ensure it meets the essential criteria for the position. You’ll be notified by HR regarding your application status as appropriate. All applicants will receive a final update once the recruitment cycle closes. Join our Talent Community through ADP to stay informed about future opportunities. Be sure to keep your resume updated in your profile. Trillium Health Resources is an Equal Employment Opportunity (EEO) employer and a drug-free workplace. All candidates must pass a drug test as a condition of employment.
Leading nationwide provider of substance use treatment offering a full continuum of care. #FreedomFromAddiction
Role Description - Conducts assessments and psychosocial evaluations on patients using criteria established by the Diagnostic and Statistical Manual of the American Psychiatric Association. - Assesses and implements the crisis plan and crisis intervention for high-risk patients (i.e. suicidal, homicidal, psychotic, aggressive) using appropriate skills and assessments. - Maintains current knowledge/level of expertise in area of specialty and various treatment modalities. - Identifies and works to resolve barriers to patients seeking and receiving behavioral health services. - Adheres to the professional standards and code of ethics set forth by applicable licensing board. - Demonstrates the ability to effectively communicate (written and verbal) with clarity and organization while ensuring appropriate communication occurs between the medical staff, leadership team, service line leadership, and team members. - Documents relevant assessment and progress updates in the medical record according to departmental standards. - Demonstrates effective decision making in a rapid-paced environment with attention to detail utilizing logical and appropriate clinical judgment. - Participates in development, implementation, evaluation, and revision of departmental policies and procedures. Qualifications - Master's degree in a relevant human services field such as Social Work, Counseling, Psychology, or Marriage and Family Therapy from an accredited school of graduate education required or an Associate's degree in Nursing; Bachelor's degree in Nursing preferred. - Full current licensure in the state of applicable state required. - 2 years of clinical experience required. Requirements - Works in the Call Center, but also areas including patient care units, emergency rooms, individual offices, and conference areas with exposure to potentially hostile patients. - Work requires frequent moving from one area to another, answering telephones, and coordinating and communicating with other staff persons in various disciplines and agencies. Benefits - Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training. - Premium pay such as shift, on call, and more based on a teammate's job. - Incentive pay for select positions. - Opportunity for annual increases based on performance. - Paid Time Off programs. - Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability. - Flexible Spending Accounts for eligible health care and dependent care expenses. - Family benefits such as adoption assistance and paid parental leave. - Defined contribution retirement plans with employer match and other financial wellness programs. - Educational Assistance Program. - Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.
Northeast Family Services (NFS) is dedicated to providing high-quality mental health services to individuals, couples, and families in settings that prioritize
Role Description Ready for a summer schedule that works for you? ☀️ Summer Fun Fridays at Northeast Family Services! We close at 12:30pm every Friday from Memorial Day through Labor Day — giving our team more time to relax, recharge, and enjoy the summer sunshine! $1000 STAY-ON BONUS! Northeast Family Services is a premier mental health provider with over 20 years of experience providing services to children, youth, and families. Are you looking for a rewarding career helping children, adults and families thrive? If you’re a dedicated mental health professional seeking a new role, we are looking for YOU! Don’t miss this opportunity to join a rapidly growing and well-regarded organization. The ISO Home Based Clinician reports to the clinical supervisor and serves as a primary therapist and contact for all in-home clients assigned. The ISO Clinician utilizes evidence-based treatment methodologies and ensures the effective implementation of all in-home treatment and programming for clients on their caseload. Positions are available NOW throughout New Hampshire! Responsibilities include: - Maintains assigned caseload and ensures the proper implementation of in-home services in accordance with referrals made by DCYF. - Works collaboratively with DCYF to respond to referral requests, create treatment plans, participate in treatment meetings, and provide regular clinical documentation. - Develops treatment plans with measurable and attainable goals in collaboration with families and DCYF. - Adheres to all documentation requirements of service delivery including assessment writing and report writing. - Participates in reporting progress to the court system through in person appearances and written reporting as requested. - Provides therapeutic intervention to children, adults, and families as assigned in home and community-based settings. - Provides parent education and supervised visitation to children, adults, and families in home and community-based settings. - Serves as clinical lead on cases when multiple providers are assigned. - Interfaces with DCYF, the NH court system, schools, behavioral health providers, and any other involved members of the treatment team as necessary to provide quality service delivery. - On-call rotation: responsible for responding to phone to provide support to families as utilized. - Early evening availability required for working hours. Most visits to clients are in the afternoon or early evenings. Must have flexible availability to work due to this. Schedule/hours are subject to our clients needs. - Successfully assesses client risk on an ongoing basis and consult with clinical supervisor regarding any safety concerns. - Transportation of clients, including children and adults, requiring car seat and booster seat installation. - Ability to successfully document all clinical contacts and documentation through Electronic Health System. - Other duties as assigned. Qualifications - Bachelor’s Degree with a major in social work, counseling, psychology or related human services field valid under NH state guidelines. - Five years minimum clinical experience working with children, adolescents, youth and families in a home or community setting preferred. - Valid driver’s license with reliable and consistent access to a vehicle; proof of insurance is required. - Applicants must be authorized to work in the U.S. We are unable to sponsor or take over sponsorship of an employment visa at this time. - Access to high speed secure internet required. Benefits - Health, dental & vision. - Summer Fun Fridays! Early Friday closures at 12:30pm from Memorial Day through Labor Day. - 3 weeks paid vacation. - 11 paid holidays (including Juneteenth, the day after Thanksgiving, Christmas Eve, and NY Eve). - Generous sick time including mental health days. - 401k retirement plan with up to 4% match. - Voluntary short and long-term disability. - Voluntary Life Insurance. - Mileage reimbursement. - Longevity award - Monetary bonus and a vacation day annually. - Company provided laptop and cell phone. - Opportunity for professional growth. - Supervision for licensure provided. - Tuition Reimbursement. - Personal cell phone discount. Compensation Full-time: Salary $55-$60k
Bringing our heart to every moment of your health.
• Conduct online “Video Visits” with health plan members • Provide 40 hours of availability weekly • Execute a strong visit completion rate, pacing 220+ completed visits per month • Maintain training, affiliation, and compliance with Video Visit requirements • Engage with manager, team, and clinical meetings • Be accountable to Signify Health operational, clinical, and member experience key performance indicators and metrics • Maintain active state licenses in coverage areas
Transforming the health of the communities we serve, one person at a time.
• Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and NCQA standards • Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal • Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards • Communicates with members, providers, facilities, and other departments regarding appeals requests • Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards • Works with leadership to increase the consistency, efficiency, and appropriateness of responses of all appeals requests • Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices • Performs other duties as assigned • Complies with all policies and standards
Transforming the health of the communities we serve, one person at a time.
• Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards • Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal • Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards • Communicates with members, providers, facilities, and other departments regarding appeals requests • Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards • Works with leadership to increase consistency, efficiency, and appropriateness of responses of all appeals requests • Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices • Performs other duties as assigned • Complies with all policies and standards
We help people live well. We’re proud to be part of Advocate Health.
• Deliver proactive coding education through newsletters, scorecards, and presentations • Lead onboarding and compliance training for all employed Physicians/APPs • Provide individualized documentation feedback by reviewing new clinician records and conducting spot checks • Serve as the primary contact for coding inquiries • Monitor Epic work queues to ensure timely and accurate charge submissions • Collaborate across departments to enhance documentation practices and system optimization • Participate in specialty and department meetings • Refine Epic documentation tools to improve efficiency and accuracy • Ensure compliance with regulatory standards
We help people live well. We’re proud to be part of Advocate Health.
• Deliver proactive coding education through newsletters, scorecards, and presentations, covering CPT (E&M, modifiers), ICD-10-CM, HCPCS, Risk Adjustment, payer requirements, and rejection resolutions. • Lead onboarding and compliance training for all employed Physicians/APPs, including Locum Tenens, residents, and students, ensuring documentation accuracy from the start. • Provide individualized documentation feedback by reviewing new clinician records and conducting spot checks, escalating non-coding issues to appropriate teams. • Serve as the primary contact for coding inquiries, coordinating with internal teams to resolve complex issues such as NCCI bundling and high-complexity charge edits. • Monitor Epic work queues (charge review, follow-up, claim edit) to ensure timely and accurate charge submissions and reduce claim denials. • Collaborate across departments—including CMOs, Clinical Informatics, Risk Adjustment, and Population Health—to enhance documentation practices and system optimization. • Participate in specialty and department meetings, identifying trends and delivering targeted education to improve coding and documentation accuracy. • Refine Epic documentation tools, including templates, order entries, diagnosis lists, and SmartSets/SmartPhrases, to improve efficiency and accuracy. • Ensure compliance with regulatory standards, including Medicare, Medicaid, and AHIMA’s Standards of Ethical Coding, while maintaining expert knowledge of evolving policies. • Promote a culture of ethical coding and continuous improvement, supporting clinicians with timely updates, feedback, and education to ensure accurate reimbursement and compliance.
WellSense Health Plan is a nonprofit health insurance company. As an employer, the company strives to foster a fast-paced, goal-motivated, and supportive cultur
Role Description The Inpatient Utilization Management Clinician is responsible for evaluating all inpatient medical treatments for medical necessity, monitoring ongoing treatment, facilitating discharge planning to ensure smooth and successful transitions of care, and collaborating with care management and medical directors to support members in achieving optimal health outcomes. Qualifications - Active, unrestricted RN license in state of residence. - Nursing degree or diploma required, bachelor’s degree in nursing preferred. - Bachelor’s degree. - RN license in state of MA, NH or compact license. - Medicare and Medicaid knowledge. Requirements - 2+ years utilization review experience and evidence-based guidelines (InterQual Guidelines). - Managed care experience. - Experience performing discharge planning. - Active, unrestricted RN license in state of residence. - Pre-employment background check. - Ability to take after hours call, including evening/nights/weekends. Benefits - Full-time remote work. - Competitive salaries. - Excellent benefits. - Generous total compensation that includes benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing. Key Functions/Responsibilities - Performs utilization review activities, including concurrent and retrospective reviews of inpatient cases applying evidenced-based InterQual® criteria and Medical Policy. - Obtains clinical information using facility EMR, where accessible, to assess and expedite timely decisions. - Determines medical appropriateness of inpatient services following evaluation of medical and contractual guidelines. - Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services. - Reviews, documents, and communicates all utilization review activities and outcomes including, but not limited to, all inquiries made and received regarding case communication. - Refers cases to Physician Reviewer when the treatment request does not meet medical necessity per guidelines, or when guidelines are not available. - Monitors inpatient cases for compliance with contractual obligations and regulatory requirements, ensuring timely reviews and authorizations. - Demonstrates strong interpersonal and communication skills when conducting reviews, interacting with physicians and staff, and ensures compliance with training on related policies and procedures. - Sends appropriate system-generated letters to provider and member. - Provides guidance and coaching to other utilization review nurses and participates in the orientation of newly hired utilization nurses. - Participates in discussions with the facility discharge planning team to improve the progression of care to the most appropriate level of care. - Identifies delays in care or services and manages with MD. - Consults with the Medical Director, as needed, for complex cases. - Follows all departmental policies and workflows in end-to-end management of cases. - Participates in team meetings, education, discussions, and related activities. - Maintains compliance with Federal, State and accreditation organizations. - Identifies opportunities for improved communication or processes. - May participate in audit activities and meetings. - Documents rate negotiation accurately for proper claims adjudication. - Identifies and refers potential cases to Care Management. - Performs all other related duties as assigned. Working Conditions and Physical Effort - Fully remote position with possible travel to the Charlestown, MA office for team meetings and training sessions. - Fast paced and dynamic work environment requiring adaptability and focus. - Minimal physical effort required; primarily desk-based tasks such as documentation and virtual meetings. - Regular and reliable attendance is essential. Compensation Range $35.58 - $51.68. This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness.
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