- Humana (Jefferson City, MO)
- …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
- Centene Corporation (Jefferson City, MO)
- …in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of ... be located in eastern or central time zone with experience in utilization management .** **Education/Experience:** Requires Graduate of an Accredited School… more
- Centene Corporation (Jefferson City, MO)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + RN - ... for our 28 million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified, national organization offering… more
- Highmark Health (Jefferson City, MO)
- …:** **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
- Highmark Health (Jefferson City, MO)
- …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 (Jefferson City, MO)
- …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 (Jefferson City, MO)
- …. 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
- Highmark Health (Jefferson City, MO)
- **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 (Jefferson City, MO)
- **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 (Jefferson City, MO)
- …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 (Jefferson City, MO)
- **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 (Jefferson City, MO)
- …**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