- CVS Health (Jefferson City, MO)
- …clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. ... ambulatory care or outpatient clinic/facility. + Valid unrestricted independent professional behavioral health clinical license to practice per state regulations… more
- Lincoln Financial (Jefferson City, MO)
- …including 1 year in claims, disability management (STD/LTD), worker's compensation, utilization review, and or behavioral health case management ... **The Role at a Glance** We are excited to bring on a knowledgeable and motivated Behavioral Health Consultant to our Clinical Organization. As a Behavioral … 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
- Elevance Health (St. Louis, MO)
- …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 (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
- Children's Mercy Kansas City (Kansas City, MO)
- …patient progression activities during the patient's hospital course, supporting utilization management functions, and administrative functions for the ... patient progression activities during the hospital stay. + Supports Utilization Management functions for Care Management...hospital setting and / or working in field of behavioral health preferred + HS diploma or… 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
- Peoples Health Centers Family of Companies (St. Louis, MO)
- Behavioral Health | Full Time Job Description About Us: BJK People's Health Centers provides comprehensive mental health services to children and adults ... needs. * Contributes to development of a recovery oriented care plans that address behavioral health , medical, and social barriers for persons served. The plans… more
- Peoples Health Centers Family of Companies (St. Louis, MO)
- …1) Functions in accordance with the policies of Betty Jean Kerr People's Health Centers Behavioral Health Division, state and federal regulation, ... or a related field and two years of post-master's experience in a behavioral health setting. Residential experience preferred. CERTIFICATION OR LICENSE REQUIRED:… more
- Peoples Health Centers Family of Companies (St. Louis, MO)
- …presents in public forums educational materials to promote community understanding of mental health and enhance community response to mental health problems. 3. ... identify problems and establish goals and objectives for treatment and assumes management responsibilities for cases assigned. 4. Participates in and contributes to… 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
- The Cigna Group (St. Louis, MO)
- …Develops and presents comprehensive clinical strategies - including formulary design and health management solutions - in collaboration with account executives ... several health -related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match,… more
- HCA Healthcare (St. Louis, MO)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... product standardization efforts, and shape the future of clinical resource management . **Benefits** HealthTrust Performance Group, offers a total rewards package… 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
- HCA Healthcare (Kansas City, MO)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... labor management , including position control, scheduling excellence, productivity management , and premium pay utilization . Maintains staffing to ensure… more
- HCA Healthcare (Kansas City, MO)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... labor management , including position control, scheduling excellence, productivity management , and premium pay utilization . Maintains staffing to ensure… more