- Bluestone Child & Adolescent Psychiatric Hospital (University Heights, OH)
- Utilization Review Registered Nurse - FT Nights, 5-8 hour shifts- Sunday through Thursday ESSENTIAL DUTIES: Immediately respond to all Bluestone Intak email, ... RN ) role as needed or when assigned by management . OTHER DUTIES: Attend scheduled staff meetings, supervision, and...Account for Health and Dependent Care JOB SUMMARY: The Utilization Review (UR) Registered Nurse … more
- Katmai (Fort Carson, CO)
- …all levels of health care management to include outside agencies. Performs utilization management activities to optimize cost, quality, and access to care. ... **Job Requirements:** **MINIMUM QUALIFICATIONS** + Associates Degree of Nursing. Registered nurse shall be a graduate from...+ Shall possess a current, active, full and unrestricted Registered Nurses ( RN ) licensed in Colorado or… more
- Commonwealth Care Alliance (Boston, MA)
- … Mgmt - Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term ... a high quality team.collaboration with the broader clinical organization. - Ensures that utilization management processes are integrated with care management … more
- Commonwealth Care Alliance (Springfield, MA)
- …significant medical, behavioral , and social complexities that require intensive care management and care delivery. Within the CIC Program, The Senior Clinician, ... to influence the clinical outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment for behavioral health needs, and closing… more
- Commonwealth Care Alliance (Boston, MA)
- …Director provides leadership, to clinicians, contracted employees and partners regarding behavioral health/substance abuse treatment and management and is ... as needed. The Director is responsible for promoting high standards of integrated behavioral health care delivery and care management practice through leading… more
- Somatus (Utica, NY)
- …+ Monitors and coaches patients using techniques of motivational interviewing and behavioral change to maximize self- management . + Oversees provisions for ... utilizing basic nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management… more
- Commonwealth Care Alliance (Springfield, MA)
- …(must have): - Meaningful clinical experience including: - 3+ years' experience as a Registered Nurse in a high-touch clinical environment or home care, OR - ... behavioral , and social complexities that require intensive care management and care delivery. Care Delivery comprises of multiple...Supervision Exercised: Yes - Assumes responsibility for all nursing ( RN , LPN) and MA roles in the practice. 10… more
- Commonwealth Care Alliance (Boston, MA)
- …(must have): - Meaningful clinical experience including: - 3+ years' experience as a Registered Nurse in a high-touch clinical environment or home care, OR - ... Manager will collaborate closely with other members of the management team. This role is full-time on site in...role. Supervision Exercised: - Assumes responsibility for all nursing ( RN , LPN) and MA roles in the practice. 10… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. - Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... in behavioral health clinical practice, provider relations, or healthcare management Desired Experience (nice to have): - Experience working with managed care… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …contractual, and legal requirements. **What you will bring** **:** **Required:** **?** + Registered Nurse - RN current state licensethat allows the ... Managers** are a dedicated team of clinicians (RNs and behavioral health professionals) who utilize a holistic model that...nationally recognized leader in the practice of integrated case management , is looking to expand our growing team of… more
- Commonwealth Care Alliance (Springfield, MA)
- …medical, behavioral , and social complexities that require intensive care management and care delivery. Within the CIC Program, the Community Health Worker ... programing is responsible for providing care delivery and care management to a specific panel of high risk and...and care coordination for the most complex medical and behavioral health patients. The CHW participates in aiding the… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …the discipline's scope of practice **(Required)** :- For nurses, required registration (eg RN , ARNP).- For behavioral health, required licensure (eg LMFT, LICSW, ... Please note this position aligns to PST business hours.** The **Manager, Case Management ** Team is a Supervisor for Case Managers. This position is responsible for… more
- Commonwealth Care Alliance (Springfield, MA)
- …Work collaboratively with internal departments-including Clinical Operations, Contracting, Network Management , Utilization Management , and Business ... & Language (nice to have):** + Familiarity with care management and utilization management systems... systems and workflows for populations with complex medical, behavioral health, and/or social needs. + Strong understanding of… more
- Commonwealth Care Alliance (Boston, MA)
- …Community Health Workers (CHWs) are key supports to interdisciplinary care management teams and complement and support enrollees' needs, goals, and preferences. ... coaching skills to improve CCA enrollee outcomes by impacting care access and utilization , closing care quality gaps, and optimizing member connection to medical, … more
- Commonwealth Care Alliance (Boston, MA)
- …delegated partnerships programs, working with clinical community partners responsible for care management and utilization management across CCA's One Care ... Knowledge, Skills, Abilities & Language (nice to have): - Familiarity with care management and utilization management systems and workflows. - Experience… more
- Commonwealth Care Alliance (Boston, MA)
- …and provider relationship management tools. - Understanding of claims operations, utilization management , and quality programs as they relate to provider ... engagement, delegation partnerships, provider services, contracting, quality, compliance, medical management , and analytics teams to advance provider network operations,… more
- Commonwealth Care Alliance (Boston, MA)
- …is responsible for providing primary care, palliative care and community intensive care management to a specific panel of high risk and complex people.? This ... patients we serve are most often are individuals with significant medical, behavioral , and social complexities that require intensive care delivery.? Within the Care… more
- Centene Corporation (Madison, WI)
- …clinicians to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) ... performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH...+ Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse -… more
- CVS Health (Des Moines, IA)
- …Service/Health Services (as applicable to hiring program) or Associates degree with a Registered Nurse with Behavioral Health experience/ background with 3 ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- Molina Healthcare (GA)
- …experience. * At least 1 year of health care management /leadership experience. * Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), Licensed ... in some or all of the following functions: care management , utilization management , behavioral...Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must… more
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