- Humana (Frankfort, KY)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work… more
- Centene Corporation (Phoenix, AZ)
- …and facilitates operations within utilization management . + Oversees the behavioral health (BH) utilization review clinicians and ensures compliance ... our Tempe and/or Tucson offices.** **Position Purpose:** Manages the behavioral health (BH) utilization review ...to members. Oversees and works with senior leadership on utilization management issues related to member care,… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing ... department activities as assigned. Essential Skills + Experience in utilization management , behavioral health, and...+ Valid Florida Driver's License. + Knowledge of case management and utilization review concepts,… more
- Omaha Children's Hospital (Omaha, NE)
- …equal opportunity employer including veterans and people with disabilities. **A Brief Overview** Utilization Management (UM) is a specialty area of Nursing Case ... a wide variety of settings. + Skills in negotiation and problem solving with utilization management . + Should be a creative, flexible, risk taker. **Licenses and… more
- Molina Healthcare (GA)
- …healthcare services professionals in some or all of the following functions: care management , utilization management , behavioral health, care ... of the following activities: care review , care management , utilization management (prior authorizations,...or more of the following areas: utilization management , care management , care transitions, behavioral… more
- CVS Health (Workman, MN)
- …partial hospitalization and intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior ... promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this… more
- Molina Healthcare (GA)
- …services professionals in some or all of the following functions: utilization management , care management , behavioral health and other programs. Leads ... care experienced in one or more of the following areas: utilization management , care management , care transitions, behavioral health, long-term services… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …delivery of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered ... within the group. + Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and… more
- CVS Health (Frankfort, KY)
- …with heart, each and every day. **Position Summary** This is a fully **remote** Utilization Review Clinical Consultant. **Must reside in the state of Kentucky or ... the standard schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Foster Care population experience +… more
- Omaha Children's Hospital (Omaha, NE)
- …equal opportunity employer including veterans and people with disabilities. **A Brief Overview** Utilization Management (UM) is a specialty area of Nursing Case ... a wide variety of settings. + Skills in negotiation and problem solving with utilization management . + Should be a creative, flexible, risk taker. **Licenses and… more
- Molina Healthcare (Rochester, NY)
- …and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …experience within insurance or health care setting in case/disease or utilization management * 3+ years of behavioral health experience * Bachelor's or ... , and business case consultant for leadership as they relate to case/disease/ utilization management . * Coordinates the development, revision and implementation… more
- Spectrum Billing Solutions (Skokie, IL)
- …Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist | UR Specialist | ... Review Specialist | ABA Utilization Review Specialist | ABA Utilization Management Specialist | ABA UR Specialist | Behavioral Health… more
- AmeriHealth Caritas (Washington, DC)
- …BONUS** **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient ... are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines to authorize services,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …healthcare? Bring your true colors to blue. The Role The Physical Therapy Utilization Management Reviewer is responsible for evaluating the appropriateness ... member's benefit to provide the best quality care. The Team The commercial Physical Therapy Utilization Management Reviewer is part of a highly dedicated and… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for members who may ... use of the member's benefit to provide the best quality care. The TeamThe Clinical Utilization Reviewer is part of a highly dedicated and motivated team of… more
- CVS Health (Oklahoma City, OK)
- …and timely discharge, appropriate follow-up care, and next steps. + Coordinate with the Utilization Management team to review medical and payer records to ... to identify and address patient needs (eg care team, social work, behavioral health, utilization management , Hard-to-Reach, Central Telehealth, etc.).… more
- Elevance Health (Columbus, OH)
- **JR167272 Manager Behavioral Health Services** Responsible for overseeing Behavioral Health Utilization Management (BH UM), this position supports the ... cost of care initiatives. + May attend meetings to review UM and/or CM process and discusses facility issues....and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience; or any combination of… more
- Centene Corporation (Indianapolis, IN)
- …Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Centene Corporation (Richmond, VA)
- …appeals, and occasional peer-to-peer consultations, as well as participating in Utilization Management clinical rounds.** **We're seeking candidates who:** + ... Kentucky license with a passion for improving access to behavioral health care? Centene is looking for a Remote...practitioners to provide education on best practice models and utilization management processes + Interact with the… more
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