Nurse Practitioner, Behavioral Health UM (PMHNP)

Performs behavioral health utilization reviews, applying evidence-based criteria, and collaborating with physicians to ensure clinically appropriate, cost-effective, and regulatory-compliant care determinations.

Assists in evaluating medical necessity, ensuring timeliness, and supporting the consistency of clinical decision-making across markets.

Participates in a team-based, physician-led model that aligns with national clinical oversight standards and enterprise behavioral health initiatives.

Contributes to overarching strategy to provide quality and cost-effective member care.

• At least 3 years of experience as a registered nurse or nurse practitioner in managed care, behavioral health or utilization management, or equivalent combination of relevant education and experience.
• Psychiatric-Mental Health Nurse Practitioner (PMHNP), and ability to obtain cross-state licensure as required. License must be active and unrestricted in state of practice.
• Current national certification (PMHNP-BC) from the American Nurses Credentialing Center (ANCC).
• Demonstrated experience in the application of medical necessity criteria and regulatory guidelines.
• Strong customer service/member-centric focus.
• Electronic Medical Record (EMR) proficiency.
• Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
• Strong time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Problem-solving skills.
• Ability to work within a variety of settings and adjust style as needed, including ability to work with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and demonstrate self-motivation.
• Ability to work cross-collaboratively within a highly matrixed organization.
• Excellent verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.