• MetroPlusHealth (New York, NY)
    …work with us. You can come to work being proud of what you do every day.The Behavioral Health Utilization Management (BH UM) Clinician is responsible for ... activities in accordance with New York State and MetroPlusHealth Utilization Management policies and procedures. The position responsibilities include… more
    Talent (10/10/25)
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  • Wexford Health Sources (Vienna, IL)
    …proven staffing expertise and a full range of medical, behavioral health , pharmacy, utilization management , provider contracting, claims processing, and ... for providing leadership in administrative matters, clinical program development, quality management , utilization management and staff education at… more
    Talent (09/29/25)
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  • MetroPlusHealth (New York, NY)
    … Home, primary caregiver, the primary and attending physicians, and various Behavioral Health and/or Substance Use Disorder providers. In partnership with ... responsible for scheduling aftercare follow-up for members discharging from an acute behavioral health inpatient setting. This position ensures that members have… more
    Talent (10/07/25)
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  • MetroPlusHealth (New York, NY)
    …trends to ensue formulary appropriateness Administers and manages all pharmacy case management programs, including the Behavioral Health Pharmacy Program ... Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If...for identifying criteria and medications to continuously improve drug utilization management strategies for the pharmacy and… more
    Talent (10/10/25)
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  • MetroPlusHealth (New York, NY)
    …of an evidence-informed, individualized Plan of Care that addresses their complex medical, behavioral health and social service needs. This position may be ... other MetroPlusHealth departments with resolution of member concerns related to retention, utilization management , quality management , customer service, and… more
    Talent (10/07/25)
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  • Senior Manager, Behavioral Health

    Centene Corporation (Phoenix, AZ)
    …to member care, provider interactions, and facilitates operations within utilization management . + Oversees the behavioral health (BH) utilization ... person meetings at our Tempe and/or Tucson offices.** **Position Purpose:** Manages the behavioral health (BH) utilization review clinicians to ensure… more
    Centene Corporation (09/14/25)
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  • Utilization Review Clinician…

    Centene Corporation (Atlanta, GA)
    …Eastern Time Zone hours.** **The ideal candidate will have experience in behavioral health utilization management .** **Education/Experience:** Requires ... million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified,...regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
    Centene Corporation (10/10/25)
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  • Utilization Management

    Humana (Frankfort, KY)
    …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
    Humana (09/27/25)
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  • Medical Director, Behavioral Health

    Molina Healthcare (Rochester, NY)
    …chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and ... and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and… more
    Molina Healthcare (10/03/25)
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  • Behavioral Health Utilization

    Actalent (Sunrise, FL)
    …and present reports on department activities as assigned. Essential Skills + Utilization management + Behavioral Health + Mental Health + Clinical ... Job Title: Behavioral Health Utilization Review... Review NurseJob Description We are seeking a dedicated Utilization Management Nurse (UMN) who will work… more
    Actalent (10/10/25)
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  • Behavioral Health Utilization

    Actalent (Sunrise, FL)
    …and present reports on department activities as assigned. Essential Skills + Experience in utilization management , behavioral health , and mental ... Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing… more
    Actalent (10/10/25)
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  • Behavioral Health Clinical Quality…

    Elevance Health (Grand Prairie, TX)
    …and a minimum of 3 years experience in quality improvement and/or behavioral health , risk management and/or utilization review in a managed care setting ... **JR167284 Behavioral Health Clinical Quality Audit Analyst, Sr** Responsible for maintaining crisis accreditation and developing, delivering and evaluating… more
    Elevance Health (10/13/25)
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  • Utilization Management Clinician…

    CVS Health (Frankfort, KY)
    …clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. ... ambulatory care or outpatient clinic/facility. + Valid unrestricted independent professional behavioral health clinical license to practice per state regulations… more
    CVS Health (10/08/25)
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  • Manager, Healthcare Services; Utilization

    Molina Healthcare (GA)
    …professionals in some or all of the following functions: care management , utilization management , behavioral health , care transitions, long-term ... or more of the following areas: utilization management , care management , care transitions, behavioral health , long-term services and supports (LTSS),… more
    Molina Healthcare (09/19/25)
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  • Nurse Supervisor, Healthcare Services…

    Molina Healthcare (Los Angeles, CA)
    …professionals in some or all of the following functions: care management , utilization management , behavioral health , care transitions, long-term ... Job Duties** * Assists in implementing health management , care management , utilization management , behavioral health and other program… more
    Molina Healthcare (09/25/25)
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  • Utilization Management Nurse…

    Omaha Children's Hospital (Omaha, NE)
    …equal opportunity employer including veterans and people with disabilities. **A Brief Overview** Utilization Management (UM) is a specialty area of Nursing Case ... variety of settings. + Skills in negotiation and problem solving with utilization management . + Should be a creative, flexible, risk taker. **Licenses and… more
    Omaha Children's Hospital (09/05/25)
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  • Chief Psychiatrist - Behavioral

    Humana (Springfield, IL)
    …administration and strategic management of behavioral and physical health services, including Utilization Management (UM), Quality Improvement, and ... specialists + Develops comprehensive care programs for the management of adult behavioral health ...Management (QM) program; and work closely with the Utilization Management (UM) of services and associated… more
    Humana (08/29/25)
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  • ABA Utilization Review (UR) Specialist

    Spectrum Billing Solutions (Skokie, IL)
    …+ Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist | UR Specialist ... Review Specialist | ABA Utilization Review Specialist | ABA Utilization Management Specialist | ABA UR Specialist | Behavioral Health Billing… more
    Spectrum Billing Solutions (09/01/25)
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  • Mobile Professional Care Manager (Hybrid)

    UPMC (Jamestown, NY)
    …Registered Nurse. + Minimum of 3 years of experience in behavioral health , clinical care, utilization management , home care, discharge planning, or ... case management . + 5 years of experience in community-based case management and behavioral health _preferred_ . + General knowledge of best practices for… more
    UPMC (08/30/25)
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  • Utilization Management Nurse…

    CVS Health (Phoenix, AZ)
    …promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this ... the forefront of clinical decision-making, applying your expertise in Behavioral Health to ensure members receive appropriate,...a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM… more
    CVS Health (10/04/25)
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