- Humana (Austin, TX)
- **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 (Austin, TX)
- …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 (Austin, TX)
- …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 (Austin, TX)
- …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
- CenterWell (Austin, TX)
- …UM Administration Coordinator - Phone Intake contributes to administration of utilization management . The UM Administration Coordinator performs varied ... best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can… more
- Molina Healthcare (Austin, TX)
- …with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization ... **JOB DESCRIPTION** **Job Summary** Molina's Behavioral Health function provides leadership and... Health function provides leadership and guidance for utilization management and case management … more
- Molina Healthcare (Austin, TX)
- …equivalent experience * 2 or more years in case, disease, or utilization management ; managed care; or medical/ behavioral health settings. * Proficient in ... development, implementation, and collaboration with the delivery of training curriculum for Utilization Management , Case Management , and LTSS staff. **Job… more
- CVS Health (Austin, TX)
- …members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , clinical ... judgment and critical thinking skills in order to facilitate appropriate physical, behavioral health , psychosocial wrap around services. The care manager will… more
- CenterWell (Austin, TX)
- …engagement, improving provider capacity by reducing administrative work related to population health management , and assisting patients with the aim of improving ... advocate for improving clinician and patient experience and effectiveness through panel management (aka population health management ) + Comfortable managing… more
- CVS Health (Austin, TX)
- …care management activities with members to ensure that their medical and behavioral health needs are met and to enhance the member's overall wellness. ... + Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate… more
- Georgetown Behavioral Health Institute (Georgetown, TX)
- … Health Institute is a 118 bed inpatient behavioral health hospital and seeking a full-time Outpatient Utilization Review Coordinator. This position ... insurance coverage and billing practices preferred. Previous experience in utilization review or case management desirable. +...Luck & we hope to meet you soon! Georgetown Behavioral Health Institute is an equal opportunity… more
- Highmark Health (Austin, TX)
- …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 (Austin, TX)
- …(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
- HCA Healthcare (Austin, TX)
- …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 ... HealthTrust Supply Chain, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and… more
- Highmark Health (Austin, TX)
- …:** **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 (Austin, TX)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job will manage small scale projects and enhancement packages with mentorship and leadership ... from more senior Delivery Owners. The incumbent provides project management leadership and facilitates the delivery of system changes from approval through to… more
- Highmark Health (Austin, TX)
- …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 (Austin, TX)
- …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 (Austin, TX)
- …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 (Austin, TX)
- **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