- Centene Corporation (Jackson, MS)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and...health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review… more
- Evolent (Jackson, MS)
- …which includes our medical reviews: LVNs, LPNs, and RNs along with our behavioral health reviewers: LMSWs, LCSW, and LPCs, Clinical Reviewers. Opportunities to ... the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point...proprietary system generating cases for both the medical and behavioral health reviewers. These requests may be… more
- Highmark Health (Jackson, MS)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... oversight over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member… more
- Highmark Health (Jackson, MS)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- Highmark Health (Jackson, MS)
- …lower-level staff. + Train, develop, and mentor staff. + Assign, monitor, and review progress and accuracy of work. + Provide technical leadership in first-line ... to maximize appropriate use of resources. + Optimize the utilization of resources by applying appropriate concepts, technologies and...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Humana (Jackson, MS)
- …of contact for the beneficiary for all activities within the medical and behavioral health spectrum. They will also coordinate with other Medical Management ... (SDOH). Plan shall include psychosocial issues, home environment and behavioral health needs across the full continuum...or Master's degree in Nursing + Prior/current experience in Utilization Management/ Utilization Review with MCG… more
- University of Southern Mississippi (Hattiesburg, MS)
- …(Moffit Health , Student Counseling Services, Athletic Training, Center for Behavioral Health , Academic Support for Student-Athletes) for the total well-being ... Close Date Open until filled Job Summary Provision of general mental health services (evaluation, treatment and education) to student athletes who are currently… more
- Sharecare (Jackson, MS)
- **Job Description:** Sharecare is the leading digital health company that helps people - no matter where they are in their health journey - unify and manage all ... their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans,… more