- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Defense Health Agency (Falls Church, VA)
- …Training (BHTRAINING); BHSL Utilization Management (BHSL UM); Primary Care Behavioral Health (PCBH); and BH Support of Traumatic Brain Injury Treatment ... will use their Behavioral Health expertise to serve as the Behavioral Health Clinical Management Team Lead (BHSL) for the DHN. Employee functions as… more
- CVS Health (Tallahassee, FL)
- …appropriate member care. . Attends and participates in case rounds, including utilization management rounds for behavioral health and physical health ... Mileage is reimbursed per our company expense reimbursement policy **Preferred Qualifications:** . Behavioral Health Experience . Case management in an… 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
- 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
- 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
- AmeriHealth Caritas (Washington, DC)
- …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
- CVS Health (Richmond, VA)
- …of care, and appropriate discharge planning + Serve as the behavioral health subject matter expert to support care management staff in serving Aetna ... foster collaboration and provide education and training + Consults with Plan executive management regarding physical and behavioral health clinical issues as… more