- Centene Corporation (Austin, TX)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
- Molina Healthcare (Dallas, TX)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS… more
- Molina Healthcare (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 with high… more
- HCA Healthcare (Fort Worth, TX)
- …interdisciplinary team members, payer representatives, and other parties as appropriate regarding behavioral services** + **Performs utilization review as ... hours volunteering in our communities. As a(an) Licensed Intake Clinician with Medical City Alliance Mental Health you can...for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services… more
- Molina Healthcare (Dallas, TX)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS ... or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina employees: If… more
- CenterWell (Arlington, TX)
- …clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify ... of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and...and monitor clinical & financial performance and metrics. + Review clinician schedules and incentive plans to… more
- CVS Health (Dallas, TX)
- …Spanish speaking **Education** Bachelor's of Science degree or non licensed master level clinician required, with either degree being in behavioral health or ... Health service strategies, policies, and programs are comprised of utilization management, quality management, network management, clinical coverage and policies.… more
- BrightSpring Health Services (San Antonio, TX)
- …+ In-service behavior clinician (s) on all changes made to regulations. + Review all billing for BCBAs, BCaBA's, RBTs and Behavior Technicians on a minimum the ... Our Company SpringHealth Behavioral Health and Integrated Care Overview Behavior Clinic...professional teams. Provide staff/family training on implemented programs. + Review all Functional Behavior Assessments/Behavior Support Plans prior to… more
- Catholic Health Initiatives (Houston, TX)
- …strategic and operational initiatives that maximize clinical operations, improve clinician alignment and satisfaction, and lead evidence-based programs, practices, ... population health management. Collect and share group trend data on resource utilization and length-of-stay, and work with councils/groups to develop, implement, and… more