- Humana (Oklahoma City, OK)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... action. + Minimum one, (1) year of experience in Behavioral Health Nursing (inpatient outpatient, psych, substance...Nursing experience + Previous experience in utilization management with ASAM knowledge + Health Plan… more
- Humana (Oklahoma City, OK)
- …Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health ; MED-Deeming accreditation standards ... degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management...knowledge is a plus. + Registered Nurse or Behavioral Health Licensed Professional. + Managed care,… more
- Humana (Oklahoma City, OK)
- …part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work… more
- Evolent (Oklahoma City, OK)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Saint Francis Health System (Tulsa, OK)
- …Skills and Abilities: Working knowledge of general disease state management processes, bio-psychosocial model, and clinical pathways. Effective interpersonal, ... toward goals. Facilitates patient discharge through timely, appropriate referrals and utilization of patient education resources, suitable to patient age and… more
- Saint Francis Health System (Muskogee, OK)
- …members; attends interdisciplinary/treatment team and patient planning meetings. Coordinate case management with utilization management . Decision Making: ... and effective patient outcomes. Minimum Education: Bachelor's Degree in a health related field. Licensure, Registration and/or Certification: None. Work Experience:… more
- CVS Health (Oklahoma City, OK)
- …discharge with adequate supervision, recommended behavioral health , physical health , pharmacy resources, and care management support. + Educates and ... every day. **Summary** : The Transition of Care Coordinator Behavioral Health utilizes advanced clinical judgment and...care to meet the member's goals. + Utilizes case management , utilization management , and quality… more
- Highmark Health (Oklahoma City, OK)
- …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...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Oklahoma City, OK)
- …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
- Highmark Health (Oklahoma City, OK)
- …(Claims, Dental Benefits, Customer Service, Membership & Billing), Provider Data Management , Underwriting, and Professional Relations. **This role will support the ... including gathering data from multiple sources related to Benefit/Claim Utilization , Enrollment, Networks ( utilization , disruption, geo-access) and making… more
- Highmark Health (Oklahoma City, OK)
- …:** **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 (Oklahoma City, OK)
- …with strong analytical and communication skills. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the… more
- Highmark Health (Oklahoma City, OK)
- …portfolio of AI-powered products, including a core administrative platform, modular utilization and care management solutions, patient-focused digital products, ... Marketing qualified leads and sales qualified leads. + Opportunity Pipeline Management : Manage and forecast the sales pipeline, providing accurate revenue… more
- Highmark Health (Oklahoma City, OK)
- …familiarity with key domains like CMS interoperability, Quality management , care & utilization management , and digital health + 3 years' experience in ... brand visibility, market intelligence, etc.) + Proposal & RFP Management : + Support proposal development timelines, coordinate input across...from lead to closure) + 3 years' experience in Health Plan Technology + 3 years' experience with solid… more
- Highmark Health (Oklahoma City, OK)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job is a strong advocate of cloud technology and engineering support necessary to drive the ... to senior or lead engineers to further cloud service utilization and optimization. + Develops automation scripts and other...of action. + Level 2 Incident, problem and change management as it pertains to the responsibilities of the… more
- Highmark Health (Oklahoma City, OK)
- …actions (promotions, hiring, terminations, etc.) Develops talent, Addresses resource management , cultivates capabilities of staff, planning and coordination of work, ... in first-line resolution of complex technical problems. + Provide Staff Management oversight. + Hire, promote, separate or make recommendations regarding same.… more
- CVS Health (Oklahoma City, OK)
- …products' specifically Excel, Outlook, and Word. **Preferred Qualifications** + Previous behavioral health experience. + Medical or insurance background. ... At CVS Health , we're building a world of health...outbound calls to providers and members, and to facilitate utilization of the Employee Assistance Program (EAP) benefits. **Position… more
- Highmark Health (Oklahoma City, OK)
- …sales revenue and expanding market share through new client acquisition and relationship management . The ideal candidate will have a strong background in B2B sales, ... as: Financial Services, Utilities, Property and Casualty Insurance + CRM utilization **Preferred** + Transactional print and mail and digital delivery experience… more
- Highmark Health (Oklahoma City, OK)
- …knowledge of clinical, quality, care, utilization , high-cost claim, and population health management . Must be a recognized subject matter expert (SME). + ... job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of...with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as… more
- Saint Francis Health System (Tulsa, OK)
- …member via committee involvement, meeting attendance, practice guideline development, utilization review, risk management activities, and continuing medical ... examine individuals to identify normal and abnormal physical and mental health findings. Knowledge of human behavior and performance, mental processes, psychological… more