- Humana (Springfield, IL)
- …help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- Humana (Springfield, IL)
- …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 (Springfield, IL)
- …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 (Springfield, IL)
- …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
- CVS Health (Springfield, IL)
- …case management for members, up to age 20, who have experienced a behavioral health crisis event. The Clinical Case Manager - BH: Utilizes advanced clinical ... advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers...up after a mobile crisis response event Partners with Utilization Management to ensure timely and safe… more
- CVS Health (Springfield, IL)
- …. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... 8:30am - 5pm within time zone of residence.** American Health Holding, Inc (AHH) is a medical management...states - 1+ years' current or previous experience in Behavioral Health - 1+ years' experience documenting… more
- CVS Health (Springfield, IL)
- …provide oversight of the design, development, and deployment of Care Management , Utilization Management , Population Health , Health Equity and Quality ... direct patient care experience. **Preferred Qualification** 1. Demonstrated experience in population health management and managed Care. 2. Passion and ability… more
- Highmark Health (Springfield, IL)
- …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 (Springfield, IL)
- …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 (Springfield, IL)
- …(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 (Springfield, IL)
- …:** **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 (Springfield, IL)
- …evaluation, coordination and management of members needs, including physical health , behavioral health , social services and community services ... the health care team, to ensure cost effective and efficient utilization of health benefits. + Decision making skills will be based upon the current needs… more
- Highmark Health (Springfield, IL)
- …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 (Springfield, IL)
- …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 (Springfield, IL)
- …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 (Springfield, IL)
- **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 (Springfield, IL)
- …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
- Highmark Health (Springfield, IL)
- …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 (Springfield, IL)
- …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
- CenterWell (Springfield, IL)
- …care that affect patient care and population management , such as quality management , utilization management , network management , and payment ... that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more… more