- Humana (Richmond, VA)
- …help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- Humana (Richmond, VA)
- …Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health ; MED-Deeming accreditation standards ... degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management...knowledge is a plus. + Registered Nurse or Behavioral Health Licensed Professional. + Managed care,… more
- Humana (Richmond, VA)
- …part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work… more
- Evolent (Richmond, VA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Bon Secours Mercy Health (Portsmouth, VA)
- …Sign on bonus eligible **Summary of Primary Function/General Purpose of Position** The Behavioral Health Registered Nurse (RN) functions as a care provider of ... Collects and records nursing assessment of the physical and behavioral health status of the patient. *...patient outcomes are met. * Participates in the safe management of the milieu, intervening effectively with patients who… more
- Elevance Health (Norfolk, VA)
- ** Behavioral Health Case Manager I** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... Richmond, VA, Roanoke, VA, Arlington, VA, Norfolk, VA The ** Behavioral Health Case Manager I** is responsible... Case Manager I** is responsible for performing case management telephonically and/or by home visits within the scope… more
- Elevance Health (Norfolk, VA)
- ** Behavioral Health Medical Director- Psychiatrist** Location: Alternate locations may be considered. This position will work a hybrid model (remote and office). ... 50 miles of an Elevance Health Pulse Point location. The ** Behavioral Health Medical Director- Psychiatrist** is responsible for completing medical necessity… more
- Veterans Affairs, Veterans Health Administration (Chesapeake County, VA)
- …Care Network (VISN 6), Hampton (HVAMC).This position is aligned under the Behavioral Health Interdisciplinary Program (BHIP)/Outpatient Services and will serve ... Summary This position is located within the Veterans Health Administration (VHA), VA Mid-Atlantic Health ...to patients; patient satisfaction activities; patient safety and risk management activities; and utilization management .… more
- Centene Corporation (Richmond, VA)
- …Assesses and performs review of member clinical records and services related to behavioral health and substance use. + Interpret and present program results ... and standards **Education/Experience:** Master's degree in Social Work or Behavioral Health or Graduate from an Accredited...the continuum of care. Experience with managed care, case management , utilization management , or quality… more
- BrightSpring Health Services (Arlington, VA)
- …pharmacy, home health care and primary care, and rehabilitation and behavioral health , we provide comprehensive and more integrated care and clinical ... home health care, + Three years' experience in an administrative/supervisory/quality management role in a Medicare certified home health agency generally… more
- Highmark Health (Richmond, VA)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Richmond, VA)
- …timeframes and notification requirements are met + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... processing of pre-certification requests for authorization of medically necessary health care services at the appropriate level of care,...and management + Route Cases Based on Established Guidelines +… more
- Elevance Health (Martinsville, VA)
- …member's circle of support and overall management of the individuals physical health (PH)/ behavioral health (BH)/LTSS needs, as required by applicable ... associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation… more
- Highmark Health (Richmond, VA)
- …(Claims, Dental Benefits, Customer Service, Membership & Billing), Provider Data Management , Underwriting, and Professional Relations. **This role will support the ... including gathering data from multiple sources related to Benefit/Claim Utilization , Enrollment, Networks ( utilization , disruption, geo-access) and making… more
- HCA Healthcare (Richmond, VA)
- …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 ... like family! Jump-start your career as a Director Clinical Quality Resource Management today with HCA Healthcare. **Benefits** HCA Healthcare, offers a total rewards… more
- HCA Healthcare (Richmond, VA)
- …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 ... and Employee Health programs. The Director of Employee and Occupational Health facilitates change management and fosters a culture of accountability and… more
- Elevance Health (Arlington, VA)
- …identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term ... chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. + Obtains a thorough and accurate… more
- Highmark Health (Richmond, VA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- HCA Healthcare (Hopewell, VA)
- …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 ... organization that invests in you as a Director Case Management ? At TriCities Hospital, you come first. HCA Healthcare...Hospital offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- HCA Healthcare (Reston, VA)
- …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 ... Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The...+ You will consult with facility-level staff regarding delegated utilization management and disease management … more