- Harris Regional Hospital (Sylva, NC)
- …spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care ... Weekends Your experience matters Harris Regional Hospital is part of Lifepoint Health , a diversified healthcare delivery network with facilities coast to coast. We… more
- AmeriHealth Caritas (LA)
- **Role Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing ... products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more… more
- CVS Health (Oklahoma City, OK)
- …+ Managed care/ utilization review experience preferred + Experience in a behavioral health inpatient setting + Ability to multitask, prioritize and ... every day. **_Work at home Position-Must Reside in Oklahoma_** **Position Summary: Behavioral Health Clinical Reviewer (LCSW, LCPC, RN)** Licensed clinical… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …a member's benefit coverage while working remotely. Primary Responsibilities * Performs behavioral health clinical utilization reviews using evidenced based ... About The Role BHPS provides Utilization Management services to its clients....* Experience with both inpatient and outpatient reviews for Behavioral Health (examples: TMS, ECT, ABA, Psychotherapy,… more
- CVS Health (Oklahoma City, OK)
- …stakeholders to identify and address patient needs (eg care team, social work, behavioral health , utilization management , Hard-to-Reach, Central ... follow-up care, and next steps. + Coordinate with the Utilization Management team to review medical and...we looking for?** **Required Qualifications** + Active RN or Behavioral Health (BH) license in good standing… more
- Molina Healthcare (Buffalo, 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
- Centene Corporation (Austin, TX)
- … Health goals for the product. + Take a macro-level view of behavioral health utilization management responsibilities to optimize clinical resource ... Provides strategic and clinical leadership for Behavioral Health across all clinical functions ( Utilization Management , Care Management , Quality, and… more
- Centene Corporation (Honolulu, HI)
- …have Behavioral Health and Substance Abuse experience. Utilization Management experience strongly preferred.** **Position Purpose:** Performs a clinical ... 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
- Humana (Indianapolis, IN)
- …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
- Molina Healthcare (Cincinnati, OH)
- …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
- 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …Summary: This position is responsible for coordinating, integrating, and monitoring the utilization of behavioral health (BH) services for members, ... of services requested for the diagnosis and treatment of members' behavioral health conditions, applying established clinical review criteria, guidelines… more
- 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health , Pharmacy, Registered ... Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health , Respiratory Therapy, Registered Dietitian, Registered Nurse,… more
- Charter Care Health Partners (Providence, RI)
- Summary: The Behavioral Health Intake and Utilization Review Coordinator is responsible for bed management , reviewing intake assessments, verifying ... Minimum 2-3 years of experience in behavioral health , preferably in intake or utilization review roles. License: RI RN License required. Skills and… more
- CVS Health (Raleigh, NC)
- …working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal departments. + ... management program. + Conduct clinical reviews for adult inpatient behavioral health cases, applying established medical necessity criteria to ensure… more
- AmeriHealth Caritas (Lafayette, LA)
- …products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more ... **Role Overview:** Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient services,… more
- Commonwealth Care Alliance (Boston, MA)
- …Utilization Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and ... of health plan QI Committee. Co-chair of health plan Utilization Management Committee...five (5) years of clinical experience in medical or behavioral health care delivery Required Knowledge, Skills… more
- Saint Francis Health System (Tulsa, OK)
- …matching the level of care utilization . Assures compliance with Managed Care Behavioral Health standards in the area of UM procedures and documentation to ... therefrom or Master's degree in Social Work, Counseling or related behavioral health field. Licensure, Registration and/or Certification: Valid multi-state… more
- State of Indiana (Indianapolis, IN)
- … outcomes through access to high quality care and services. You serve as the utilization management subject-matter expert in health care delivery, develops ... Utilization Management Manager Date Posted: Nov... Utilization Management Manager Date Posted: Nov 1, 2025 Requisition...program + Employee assistance program that allows for covered behavioral health visits + Qualified employer for… more
