- Humana (Charleston, WV)
- …us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional who utilizes ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- Highmark Health (Charleston, WV)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- Elevance Health (Charleston, WV)
- …to day clinical responsibilities means that the medical director is directly involved in Utilization Management and Case Management . + Daily case reviews for ... medical director provides clinical expertise in all aspects of utilization review and case management . Provides input...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
- Highmark Health (Charleston, WV)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Charleston, WV)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... processing of pre-certification requests for authorization of medically necessary health care services, at the appropriate level of care,...and management . + Route Cases Based on Established Guidelines. +… more
- CVS Health (Charleston, WV)
- …. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health /Substance Abuse or Maternity/ Obstetrics experience.… more
- BrightSpring Health Services (Dunbar, WV)
- …community living, adult host homes for adults regardless of disability, behavioral /mental health support, in-home pharmacy solutions, telecare and remote ... ResCare Community Living Overview This position plans, directs, and coordinates health services for all assigned service sites. Provides oversight and direction… more
- Highmark Health (Charleston, WV)
- …in the use of user interfaces, predicative analytic tools, and other population health management tools endorsed by Highmark. + Independently and autonomously ... Experience with Medicare STARS, Medicaid HEDIS, risk revenue value streams, and population health management **Preferred** + 7 years in a government program… more
- Highmark Health (Charleston, WV)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job plays a key role in ensuring projects (ie change initiatives) meet objectives on time ... and minimize risk to implementation. Works to drive faster adoption, higher ultimate utilization and greater proficiency of the changes that impact employees in the… more
- Highmark Health (Charleston, WV)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This role is responsible for designing, developing, implementing, supporting, and optimizing ... solutions, networks, and infrastructure. Ensure optimal technology selection, resource utilization , and seamless integration. + Utilize modeling tools to develop… more
- Highmark Health (Charleston, WV)
- …within the Scrum Master and PO CoE teams through coaching, performance management , and fostering collaboration. The manager provides **oversight for Scrum Masters** ... **leading the Agile Transformation** , including strategic planning, change management , stakeholder engagement, tracking transformation metrics, and fostering continuous… more
- Highmark Health (Charleston, WV)
- **Company :** Allegheny Health Network **Job Description :** Applicants must be authorized to work in the US independently. At this time, we do not offer visa ... of data, analyses, slides and preparation for CMS TEAMS and ED CT Utilization workgroups + Exposure to VBR work, including various programs, models, contracts, etc.… more
- Highmark Health (Charleston, WV)
- …**Preferred** + 5 years of experience with communications + 3 years of experience in Utilization Review + 3 years of experience in Account Support + 1 year of ... + In-depth knowledge of the pharmacy industry, including benefit design, formulary management , and pharmacy best practices. + Proven ability to interpret and analyze… more