• Utilization Management

    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
    Humana (09/27/25)
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  • Senior Manager, Behavioral Health…

    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
    Centene Corporation (09/14/25)
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  • Behavioral Health Utilization

    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
    Actalent (10/04/25)
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  • Utilization Management Nurse…

    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
    Omaha Children's Hospital (09/05/25)
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  • Manager, Healthcare Services; Utilization

    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
    Molina Healthcare (09/19/25)
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  • Utilization Management Nurse…

    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
    CVS Health (10/04/25)
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  • Director, Healthcare Services; Utilization

    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
    Molina Healthcare (09/19/25)
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  • Case Manager, RN or Licensed Behavioral

    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
    Excellus BlueCross BlueShield (09/30/25)
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  • Behavioral Health Utilization

    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
    CVS Health (09/13/25)
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  • Utilization Management Nurse - 20…

    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
    Omaha Children's Hospital (09/05/25)
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  • Medical Director, Behavioral Health (WA)

    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
    Molina Healthcare (10/03/25)
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  • Manager Clinical Care Management

    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
    Blue Cross and Blue Shield of Minnesota (09/10/25)
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  • ABA Utilization Review (UR)…

    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
    Spectrum Billing Solutions (09/01/25)
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  • Utilization Management

    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
    AmeriHealth Caritas (09/01/25)
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  • Physical Therapy Utilization

    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 (08/13/25)
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  • RN Utilization Management

    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
    Blue Cross Blue Shield of Massachusetts (09/19/25)
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  • Transitional Care Manager, Behavioral

    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
    CVS Health (09/17/25)
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  • Manager Behavioral Health Services

    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
    Elevance Health (09/30/25)
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  • Psychologist Reviewer

    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 (09/04/25)
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  • Psychologist Reviewer

    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
    Centene Corporation (09/07/25)
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