- Actalent (Sunrise, FL)
- Utilization Management Behavioral Health ClinicianUtilization Management Behavioral Health Clinician We're seeking a dedicated Behavioral ... Health Clinician to join our Utilization Management team. In this role, you'll collaborate with an...Conduct utilization reviews and service authorizations for behavioral health and substance use treatments. +… more
- Centene Corporation (Austin, TX)
- …appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization ... CANDIDATE WILL HAVE BCBA CERTIFICATION **Position Purpose:** Supervises the behavioral health (BH) utilization review...performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH… more
- CVS Health (Frankfort, KY)
- …FOR LICENSING DETAILS_** This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna Better Health of Kentucky. ... management function. **Required Qualifications** + **_Kentucky Licensed Independent Behavioral Health Clinician (_** **_LPCC, LCSW, LMFT, LPAT_** **_)… more
- San Antonio Behavioral Health (San Antonio, TX)
- …changed with or without notice. Knowledge Skills and Abilities . Relevant experience in utilization management , behavioral health , or a related clinical ... Director of Utilization Review (UR) in a behavioral health setting oversees the UR process,...with clinical staff to ensure optimal patient outcomes. Overseas utilization management and criteria-based reviews of care,… more
- Elevance Health (Los Angeles, CA)
- …and Experiences:** + 2+ years of experience in a managed care organization in a utilization management behavioral health role preferred. For candidates ... the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health ...is licensed staff supervision. + Previous experience in case management / utilization management with a broad… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of consistent and quality health care services. Examples may include Utilization Management , Quality, Behavioral Health , Pharmacy, Registered ... health care cost drivers. Essential Accountabilities: Level I * Handles behavioral health member clinical management programs. * Maintains knowledge… 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
- CVS Health (Frankfort, KY)
- …meetings when requested * Oversight and implementation of the utilization management program for behavioral health services, including preventing ... health plan. They will have key roles in utilization management and case management ...development of clinical practice standards, policies, and procedures * Behavioral health care management performance… more
- Ascension Health (Indianapolis, IN)
- …of: + Discharge planning + Medicare/Medicaid regulations + Utilization review and management + Behavioral health and social determinants of health ... **Details** + **Department: Case Management - Central Region** + **Hospital: Ascension St. Vincent**...transfer date. + Social Worker credentialed from the Indiana Behavioral Health and Human Services Licensing Board… more
- Centene Corporation (Olympia, WA)
- …and support of the Chief Medical Officer to direct and coordinate the behavioral health medical management , quality improvement and credentialing functions ... as mental health parity, community services overutilization, prior authorization, and utilization management reform. + Serve as the internal subject matter… more
- Centene Corporation (Olympia, WA)
- …as mental health parity, community services overutilization, prior authorization, and utilization management reform. + Serve as the internal subject matter ... as mental health parity, community services overutilization, prior authorization, and utilization management reform. + Analyze data related to behavioral … more
- Baylor Scott & White Health (Dallas, TX)
- …experience and/or behavioral health treatment + Experience with Utilization Management for Substance use treatment experience and/or behavioral ... and improving care quality. **Essential Functions of the Role** + Process all Behavioral Health and Substance Use Disorder authorizations within the designated… more
- HCA Healthcare (Richmond, VA)
- …you want to join an organization that invests in you as a(an) Case Manager Behavioral Utilization Management ? At Chippenham Hospital, you come first. HCA ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free...difference. We are looking for a dedicated Case Manager Behavioral Utilization Management like you… more
- Sutter Health (Berkeley, CA)
- …systems for the appeal/denial process, tracks and trends data, and coordinates utilization management activities for the assigned area. Collaborates with ... staff changes, workload, or technical development)._ **DEPARTMENT REQUIRED EDUCATION** Department, Behavioral Health : Master's in Social Work or related field… more
- AdventHealth (Glendale Heights, IL)
- …AVE, Glendale Heights, IL 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by ... including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a...+ Associate's of Nursing Required + RN experience in behavioral health preferred + Must be able… more
- Centene Corporation (Columbus, OH)
- …who reside in either central or eastern time zone with experience in mental health settings and utilization management / review. * Department: PHCO ... 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
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for ... compliance reviews as needed. + Continuously monitors regulatory requirements for Utilization Management . + Attends Mandatory Education programs required by… more
- McLaren Health Care (Indianapolis, IN)
- We are looking for a Utilization Management RN, to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of ... Inc. at https://www.mdwise.org/ . **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- AmeriHealth Caritas (Newtown Square, PA)
- … management strategies. + Works closely with a multidisciplinary team to ensure behavioral health management and quality management programs are ... products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more… more
- Beth Israel Lahey Health (Burlington, MA)
- …of three years of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ... team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg experience… more