2358 Bristol jobs in Cumberland,RI

Telephone Screener (Remote)

Hire Standard Staffing

Cumberland, RI

Must be a U.S. or Canadian citizen.
Comfortable using Zoom and other online communication tools.
No prior insurance experience is required — only a strong drive to succeed and a willingness to learn.

Adecco

Cumberland, RI 02864

Active, unrestricted Arizona License (LCSW, LPC, or LMFT) OR an RN with a compact license and a behavioral health focus
Must reside in Arizona
Monday–Friday, 8:00 AM – 5:00 PM AZ Time
Occasional holiday/weekend rotation required
BH Utilization Management: Experience in initial/concurrent reviews and discharge planning
Clinical Assessment: Strong critical thinking skills to evaluate records and balance quality with resource utilization
Communication: Ability to coordinate effectively across stakeholders and provide provider education on UM processes
Clinical Review: Apply medical necessity criteria, policies, and professional judgment to render coverage and discharge planning decisions
Care Coordination: Communicate with healthcare providers and internal teams to facilitate timely authorizations and continuity of care
Concurrent Review: Monitor ongoing inpatient or outpatient treatment to ensure services align with evidence-based standards
Crisis Support: Provide urgent clinical interventions, including triage and crisis support when required
Optimization: Identify opportunities to reduce unnecessary services while promoting high-quality, member-centered care
Documentation: Maintain audit-ready clinical reports and monitor KPIs