• Utilization Management

    CVS Health (Richmond, VA)
    …No weekends or holidays. + 1+ years of utilization review/ utilization management required. + 3+ years of behavioral health clinical experience in a ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
    CVS Health (06/25/25)
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  • LTSS Service Coordinator - RN Clinician

    Elevance Health (Arlington, VA)
    …to client needs, and direct, hands-on engagement. The **LTSS Service Coordinator RN Clinician ** is responsible for overall management of member's case within the ... face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral more
    Elevance Health (06/21/25)
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  • RN Care Review Clinician , Inpatient Review

    Molina Healthcare (Roanoke, VA)
    Behavioral health services. Strongly prefer candidates with a background on utilization management or appeals. Excellent computer multi-tasking skills and ... Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina… more
    Molina Healthcare (06/22/25)
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  • Market CMO

    CenterWell (Richmond, VA)
    …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities ... care team, combining clinical practice experience with leadership and operational management to ensure high-quality patient care and alignment with Value-Based Care… more
    CenterWell (06/13/25)
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  • VP, Centerwell PCO, IPA CMO

    CenterWell (Richmond, VA)
    …care that affect patient care and population management , such as quality management , utilization management , network management , and payment ... patients at national scale. S/he will be a proven clinician , leader, and strategist capable of driving the highest...quality/STARS, efficiency of care, and improved clinical outcomes and utilization . + Identify and act on opportunities to better… more
    CenterWell (05/28/25)
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  • inTransition Coach, Federal Service Center

    KSA Integration LLC (Arlington, VA)
    …experience post degree in psychiatric and/or substance abuse health care setting, including utilization review. + Requires a Master's level clinician with a MA, ... DHA, DoD, or VA healthcare programs. + Familiarity with behavioral health coaching models or case management ...with behavioral health coaching models or case management practices. + Previous Experience working with the Veteran… more
    KSA Integration LLC (05/31/25)
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  • Analyst Case Manager- West Virginia

    CVS Health (Richmond, VA)
    …experience * Foster care experience * Crisis intervention skills * Managed care/ utilization review experience * Case management and discharge planning experience ... * Familiarity with QuickBase **Education** Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or… more
    CVS Health (06/14/25)
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  • Clinical Informaticist Registered Nurse RN

    HCA Healthcare (Richmond, VA)
    …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 medical ... to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Henrico Doctors' Hospital Forest!… more
    HCA Healthcare (06/21/25)
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