- Baylor Scott & White Health (Dallas, TX)
- …+ Experience working with Substance use treatment experience and/or behavioral health treatment + Experience with Utilization Management for Substance use ... vary based on position type and/or level **Job Summary** Utilization Review Specialist conducts reviews and shares...quality. **Essential Functions of the Role** + Process all Behavioral Health and Substance Use Disorder authorizations… more
- Centene Corporation (Austin, TX)
- …LMHC license or have a compact RN license with previous behavioral health experience. **Position Purpose:** Performs a clinical review and assesses care ... accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH)...health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review… more
- Immigration and Customs Enforcement (Los Fresnos, TX)
- …Suicide Risk management, etc.) and work collaboratively to address the same. Participates in review of behavioral health processes and procedures within the ... Office of the Deputy Assistant Director of Clinical Services, Behavioral Health Unit (BHU). This position is...identified as having a serious mental illness using Mental Health Review form (IHSC-883). Works in conjunction… more
- Prime Healthcare (Weslaco, TX)
- …facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and ... demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery...to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,… more
- Centene Corporation (Austin, TX)
- …the medical management, quality improvement and credentialing functions for the business unit ( behavioral health ). + Provides medical leadership of all for ... containment, and associated activities including quality improvement . + Performs medical review activities pertaining to utilization review , quality… more
- Molina Healthcare (Fort Worth, TX)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... transplants; the ideal candidate will have experience either in utilization review or case management for transplants....an integrated delivery of care across the continuum, including behavioral health and long-term care, for members… more
- BrightSpring Health Services (San Antonio, TX)
- Our Company SpringHealth Behavioral Health and Integrated Care Overview Behavior Clinic Supervisor for Youth ABA Line of Business MUST BE A FULLY LICENSED BCBA ... program development + Meet with school districts to provide current information on Spring Health Behavioral Health and Integrated Care Services + Explore… more
- Georgetown Behavioral Health Institute (Georgetown, TX)
- …Behavioral Health Institute is a 118 bed inpatient behavioral health hospital and seeking a full-time Outpatient Utilization Review Coordinator. ... access the full range of their benefits through the utilization review process. Requirements + Education: Master's...Luck & we hope to meet you soon! Georgetown Behavioral Health Institute is an equal opportunity… more
- Veterans Affairs, Veterans Health Administration (Corpus Christi, TX)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants may not apply. Responsibilities ... The Intensive Community Mental Health Recovery Rural Access network for Growth Enhancement (ICMHR-RANGE)...and a part of the Veteran's recovery plan. Ensures utilization of government owned equipment (ie, laptop computers, phones,… more
- CVS Health (Dallas, TX)
- …judgment and critical thinking skills in order to facilitate appropriate physical, behavioral health , psychosocial wrap around services. The care manager will ... and company policies and procedures. **Required Qualifications** - 2+ years of experience in behavioral health or social services required - A minimum of a… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Additional applications will be referred as needed. GS-11: Conducts mental health assessments to diagnose conditions and develop treatment plans. Provides… more
- Baylor Scott & White Health (Round Rock, TX)
- …coordinate patient care across the continuum. This includes case management, social work, utilization review , and care coordination. The goal is to achieve ... **About Us** Here at Baylor Scott & White Health we promote the well-being of all individuals,...related to care coordination, discharge planning, case management, and utilization review . Monitors processes and systems for… more
- CVS Health (Dallas, TX)
- …judgment and critical thinking skills in order to facilitate appropriate physical, behavioral health , psychosocial wrap around services. + The care manager ... policies and procedures. **Required Qualifications** + 2+ years of experience in behavioral health or social services + Must possess reliable transportation… more
- Highmark Health (Austin, TX)
- …**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
- Catholic Health Initiatives (Houston, TX)
- …to conduct the work of clinical operations, clinical integration, and population health management. Collect and share group trend data on resource utilization ... develop, implement, and monitor improvement plans. + **Care Coordination & Utilization Management:** Actively participate in the care coordination program, including… more
- Highmark Health (Austin, TX)
- …SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services, application of ... utilization , identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors ... status of approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of… more
- HCA Healthcare (San Antonio, 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 ... + Participates in developing department goals/objectives and clinical programming. Performs utilization review as assigned. + Assists with Process and… more
- Highmark Health (Austin, TX)
- …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
- CenterWell (Austin, TX)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... consistent and standardized program workflows, dyad communication/partnership, and quarterly business review of acute care and post-acute care utilization . +… more