- Humana (Madison, WI)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... action. + Minimum one, (1) year of experience in Behavioral Health Nursing (inpatient outpatient, psych, substance...Nursing experience + Previous experience in utilization management with ASAM knowledge + Health Plan… more
- Humana (Madison, WI)
- …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 (Madison, WI)
- …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 (Madison, WI)
- …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
- Molina Healthcare (Racine, WI)
- …with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization ... **JOB DESCRIPTION** **Job Summary** Molina's Behavioral Health function provides leadership and... Health function provides leadership and guidance for utilization management and case management … more
- Vighter Medical Group (Big Bend, WI)
- Supervisory Behavioral Health Advisor (SBHA), Local, Big Bend, Texas Job Details Job Location Big Bend, TX - Big Bend, TX Position Type Full Time Education Level ... Percentage Up to 25% Job Shift Any Job Category Health Care Description Title:Supervisory Behavioral Health...of sector wide BH programing to optimize access and utilization . + Provide professional direction, oversight, and consultation of… more
- Elevance Health (Waukesha, WI)
- ** 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
- Molina Healthcare (WI)
- …equivalent experience * 2 or more years in case, disease, or utilization management ; managed care; or medical/ behavioral health settings. * Proficient in ... development, implementation, and collaboration with the delivery of training curriculum for Utilization Management , Case Management , and LTSS staff. **Job… more
- Centene Corporation (Madison, WI)
- …functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate,… more
- Highmark Health (Madison, WI)
- …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 (Madison, WI)
- …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
- Highmark Health (Madison, WI)
- …(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
- Highmark Health (Madison, WI)
- …:** **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
- Ascension Health (Appleton, WI)
- …promote and oversee patient safety, continuous performance and quality improvement, risk management and efficient resource utilization . + Provides leadership to ... you have minor medical issues. **Benefits** Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans… more
- Highmark Health (Madison, WI)
- …with strong analytical and communication skills. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the… more
- Highmark Health (Madison, WI)
- …portfolio of AI-powered products, including a core administrative platform, modular utilization and care management solutions, patient-focused digital products, ... Marketing qualified leads and sales qualified leads. + Opportunity Pipeline Management : Manage and forecast the sales pipeline, providing accurate revenue… more
- Highmark Health (Madison, WI)
- …familiarity with key domains like CMS interoperability, Quality management , care & utilization management , and digital health + 3 years' experience in ... brand visibility, market intelligence, etc.) + Proposal & RFP Management : + Support proposal development timelines, coordinate input across...from lead to closure) + 3 years' experience in Health Plan Technology + 3 years' experience with solid… more
- Highmark Health (Madison, WI)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job is a strong advocate of cloud technology and engineering support necessary to drive the ... to senior or lead engineers to further cloud service utilization and optimization. + Develops automation scripts and other...of action. + Level 2 Incident, problem and change management as it pertains to the responsibilities of the… more
- Highmark Health (Madison, WI)
- …actions (promotions, hiring, terminations, etc.) Develops talent, Addresses resource management , cultivates capabilities of staff, planning and coordination of work, ... in first-line resolution of complex technical problems. + Provide Staff Management oversight. + Hire, promote, separate or make recommendations regarding same.… more
- Molina Healthcare (WI)
- … health plan's Healthcare Services (clinical operations) teams including Utilization Management (prior-authorization, inpatient review) and Care Management ... an integrated delivery of care across the continuum, including behavioral health and long-term care, for members...(RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health … more