- CVS Health (Phoenix, AZ)
- …meaningful difference in the lives of children and adolescents? Join Mercy Care as a Behavioral Health Utilization Management Clinician and become part ... of Child Safety (DCS). + Knowledge of Behavioral Health Outpatient Services. + Utilization Management (UM) Experience. **Education** + Master's degree… more
- Elevance Health (Wallingford, CT)
- …workplace. Alternate locations may be considered. This position will be directly responsible for Behavioral Health Utilization Management (BH UM) only ... The **Manager Behavioral Health Services** is responsible for Behavioral Health Utilization Management (BH UM), or Behavioral Health Case… more
- Elevance Health (Baton Rouge, LA)
- …and a minimum of 3 years experience in quality improvement and/or behavioral health , risk management and/or utilization review in a managed care setting ... studies including, but not limited to the development and implementation of behavioral health outcomes improvement interventions such as newsletter article,… more
- Centene Corporation (San Antonio, TX)
- …and substance abuse is preferred. + Utilization Review/ Utilization management with behavioral health cases + Precertification, Concurrent Review, ... million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified,...regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
- Elevance Health (Cerritos, CA)
- …and Experiences:** + 2+ years of experience in a managed care organization in a utilization management behavioral health role preferred. For candidates ... the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health ...is licensed staff supervision. + Previous experience in case management / utilization management with a broad… more
- Humana (Oklahoma City, OK)
- …a part of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within… more
- CVS Health (Frankfort, KY)
- …FOR LICENSING DETAILS_** This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna Better Health of Kentucky. ... management function. **Required Qualifications** + **_Kentucky Licensed Independent Behavioral Health Clinician (_** **_LPCC, LCSW, LMFT, LPAT_** **_)… more
- UPMC (Pittsburgh, PA)
- …functions through the management of staff and activity which may include behavioral health , utilization management and care management ... **UPMC Health Plan is looking for a Statewide LTSS...for improvement. Supports supervisors managing service coordination and care management staff. **Responsibilities:** + Selects, schedules, assigns, and evaluates… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health , Pharmacy, Registered ... Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health , Respiratory Therapy, Registered Dietitian, Registered Nurse,… more
- Centene Corporation (Raleigh, NC)
- …in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of ... million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified,...WORK 10 HOURS.** **THIS ROLE WILL MAINLY SUPPORT MEDICARE BEHAVIORAL HEALTH ALL STATES AND DELAWARE MEDICAID… more
- AdventHealth (Glendale Heights, IL)
- …AVE, Glendale Heights, IL 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by ... including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a...+ Associate's of Nursing Required + RN experience in behavioral health preferred + Must be able… more
- Highmark Health (Dover, DE)
- …internal departments including but not limited to Medical Directors, Behavioral Health Teams, Disease Management , and Utilization Review. The incumbent ... including but not limited to Medical Directors, Behavioral Health Teams, Disease Management , and Utilization Review. + Accountable for special projects… more
- CVS Health (Charleston, WV)
- …utilization /benefit management function. Required Qualifications: + Licensed independent Behavioral Health clinician or a Registered Nurse (RN) with ... do it all with heart, each and every day. ** Utilization Management Clinical Consultant** **Remote - West...utilization review experience preferred + Experience in a behavioral health inpatient setting + Ability to… more
- Highmark Health (Sacramento, CA)
- …Proven ability to deliver engaging and informative product demonstrations and walkthroughs. + ** Utilization Management & Clinical Expertise:** + Utilization ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** If located...Management Knowledge: A strong understanding of utilization management principles, processes, and industry best… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... compliance reviews as needed. + Continuously monitors regulatory requirements for Utilization Management . + Attends Mandatory Education programs required by… more
- McLaren Health Care (Indianapolis, IN)
- We are looking for a Utilization Management RN, to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of ... Inc. at https://www.mdwise.org/ . **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- UnityPoint Health (Cedar Rapids, IA)
- …Shift: 40 Hours Per Week + Job ID: 168048 Overview The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves ... a fulfilling career and make a difference with UnityPoint Health . Responsibilities Utilization Management +...related field or an RN + Two years of behavioral health work experience. + Professional communication… more
- State of Indiana (Indianapolis, IN)
- … outcomes through access to high quality care and services. You serve as the utilization management subject-matter expert in health care delivery, develops ... Utilization Management Manager Date Posted: Jul...program + Employee assistance program that allows for covered behavioral health visits + Qualified employer for… more
- Beth Israel Lahey Health (Burlington, MA)
- …of three years of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ... team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg experience… more
- AmeriHealth Caritas (LA)
- …products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more ... Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services,… more