- Sutter Health (Berkeley, CA)
- …staff changes, workload, or technical development)._ **DEPARTMENT REQUIRED EDUCATION** Department, Behavioral Health : Master's in Social Work or related field ... with hospital administration, medical staff, patient registration and representatives of review organizations and others to ensure effective utilization of… more
- Centene Corporation (Austin, TX)
- …LMHC license or have a compact RN license with previous behavioral health experience. **Position Purpose:** Performs a clinical review and assesses care ... accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH)...health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review… more
- AdventHealth (Glendale Heights, IL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use...+ Associate's of Nursing Required + RN experience in behavioral health preferred + Must be able… more
- Spectrum Billing Solutions (Skokie, IL)
- …conference reviews. Minimum requirements: + 3-5 years of experience in utilization review for behavioral health services. + Bachelor's or Master's ... for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing...(Word, Excel, billing software). + Understanding of mental and behavioral health treatment services. At Spectrum, you… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** The Sr Clinician, Behavioral Health Utilization Review will review behavioral ... behavioral health managed care preferred + Experience in behavioral health utilization review or medical necessity evaluation preferred… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Director of Utilization Review (UR) in a behavioral health setting oversees the UR process, ensuring appropriate and cost-effective care while ... with or without notice. Knowledge Skills and Abilities . Relevant experience in utilization management, behavioral health , or a related clinical setting.… more
- Baylor Scott & White Health (Dallas, TX)
- …+ Experience working with Substance use treatment experience and/or behavioral health treatment + Experience with Utilization Management for Substance use ... vary based on position type and/or level **Job Summary** Utilization Review Specialist conducts reviews and shares...quality. **Essential Functions of the Role** + Process all Behavioral Health and Substance Use Disorder authorizations… more
- Centene Corporation (Austin, TX)
- …CANDIDATE WILL HAVE BCBA CERTIFICATION **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate ... BH utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines +… more
- Independent Health (Buffalo, NY)
- …benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Behavioral Health Utilization Review Clinician will primarily ... be responsible for managing behavioral health benefits through utilization management functions as...services requested for the diagnosis and treatment of members' health conditions, applying established clinical review criteria,… more
- Ascension Health (Indianapolis, IN)
- …understanding of: + Discharge planning + Medicare/Medicaid regulations + Utilization review and management + Behavioral health and social determinants ... date or job transfer date. + Social Worker credentialed from the Indiana Behavioral Health and Human Services Licensing Board obtained prior to hire date or job… more
- CVS Health (Frankfort, KY)
- …clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. ... /benefit management function. **Required Qualifications** + **_Kentucky Licensed Independent Behavioral Health Clinician (_** **_LPCC, LCSW, LMFT, LPAT_**… more
- Actalent (Sunrise, FL)
- Utilization Management Behavioral Health ClinicianUtilization Management Behavioral Health Clinician We're seeking a dedicated Behavioral ... this role, you'll collaborate with an interdisciplinary team to review and authorize behavioral health ...Conduct utilization reviews and service authorizations for behavioral health and substance use treatments. +… more
- Beth Israel Lahey Health (Burlington, MA)
- …making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse (RN) Case ... Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality...review medical necessity and discharge planning) **As a health care organization, we have a responsibility to do… more
- Centene Corporation (New York, NY)
- …degree for behavioral health clinicians preferred. Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans ... of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder...required. Knowledge of ABA services and BH utilization review process required. Experience working with… more
- LifePoint Health (Louisburg, NC)
- Registered Nurse (RN) Utilization Review Job Type: Full Time | Day Your experience matters At Maria Parham Hospital, we are driven by a profound commitment to ... text outlines the responsibilities involved in monitoring adherence to the hospital's utilization review plan, which ensures the appropriate use of hospital… more
- HCA Healthcare (Nashville, TN)
- **Description** **Introduction** Do you have the career opportunities as a(an) Utilization Review Services RN you want with your current employer? We have an ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free...of colleagues. Do you want to work as a(an) Utilization Review Services RN where your passion… more
- AmeriHealth Caritas (Washington, DC)
- …Director for further review . The reviewer independently applies medical and behavioral health guidelines to authorize services, ensuring they meet the ... managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover… more
- BriteLife Recovery (Englewood, NJ)
- …in utilization review , case management, or insurance coordination in a behavioral health or substance use treatment setting. + Knowledge of ASAM criteria ... What you will be doing? The Utilization Review (UR) Specialist is a...and a working knowledge of insurance guidelines specific to behavioral health What tasks are required? +… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team. The Utilization ... clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and...(Word, Excel, billing software). + Understanding of mental and behavioral health treatment services. At Spectrum, you… more
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as a Utilization Review Services Coordinator? At Parallonr, you come first. HCA Healthcare has ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free...make a difference. We are looking for a dedicated Utilization Review Services Coordinator like you to… more
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