- Humana (Concord, NH)
- …and help us put health first** Full-Time Remote, Telephonic RN opportunity. The Utilization Management Behavioral Health Nurse utilizes behavioral ... years of clinical and Utilization Management experience. The Utilization Management Behavioral Health Nurse completes medical record reviews from… more
- Humana (Concord, NH)
- …community and help us put health first** Humana Healthy Horizons 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
- WellSense (Manchester, NH)
- …services. The Licensed Behavioral Health Clinician works alongside medical Utilization Management and medical Care Management staff, pharmacists, and ... circumstances. Guaranteed $5,000 Sign on Bonus **Job Summary:** The Licensed Behavioral Health Clinician provides care management services at facilities, in… more
- Humana (Concord, NH)
- …+ Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health . + Detailed working knowledge in ... degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management...Working knowledge using Power BI + Registered Nurse or Behavioral Health Licensed Professional. + Managed care,… more
- Lincoln Financial Group (Concord, NH)
- …including 1 year in claims, disability management (STD/LTD), worker's compensation, utilization review, and or behavioral health case management ... **The Role at a Glance** We are excited to bring on a knowledgeable and motivated Behavioral Health Consultant to our Clinical Organization to work in one of our… more
- Humana (Concord, NH)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post acute services such as ... part of our caring community and help us put health first** The Behavioral Health ...health insurance, other healthcare providers, clinical group practice management . + Utilization management experience… more
- Centene Corporation (Bedford, NH)
- …and case management activities **Education/Experience:** Master's in Social Work / Behavioral health . 5+ years of experience in managed care, utilization ... for our 28 million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified, national organization offering… more
- Highmark Health (Concord, NH)
- …account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and case/ disease management ... information to improve individual outcomes as an adjunct to health coaching. If acting in the capacity as a...review. + Assist in the development and implementation of utilization management programs including but not limited… more
- Covenant Health (Nashua, NH)
- …Case Manager works closely with, and delegates care to, the High-Risk Social Worker/ Behavioral Health Clinician because of assessment and determination of social ... to receive services. + Delegates cases to High-Risk Social Worker/ Behavioral Health Clinician based on assessment including...of five years broad clinical experience preferred + Case management and/or Utilization Management experience… more
- Highmark Health (Concord, NH)
- …for the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review. Ensures all accurate information is ... including verification of benefit eligibility. Build cases in the utilization management system. + Use knowledge of...0 - 1 year of experience working in the Health Insurance Industry **LICENSES AND CERTIFICATIONS** **Required** + None… more
- Humana (Concord, NH)
- …experience leading teams focusing on quality management , utilization management , discharge planning and/or home health or rehab. + Strategic thinking ... the senior population with a strong lens on intersecting behavioral and social health needs. + Provide...management , utilization management , case management , discharge planning and/or home health or… more
- Beth Israel Lahey Health (Lawrence, MA)
- …Day (United States of America) Clinical Supervisor (LICSW / LMHC) - Community Behavioral Health Center located in Lawrence, MA. **Job Description:** + **Sign ... of the Urgent Care/Mobile Crisis Program, including the appropriate utilization and management of staff and quality...Medicaid and non-Medicaid services. Ensures smooth access to MassHealth behavioral health services in the area by… more
- Elevance Health (Manchester, NH)
- …are not limited to: + This position will be the finance lead for our Behavioral Health Specialty product (CCPSMI) for individuals with serious mental illness and ... some of which may pose as legitimate companies. Elevance Health requires a completed online application for consideration of...analysis for lines of business. Has end to end ownership/ management of business processes and works across functions and… more
- Elevance Health (Manchester, NH)
- …evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and community services ... the health care team, to ensure cost effective and efficient utilization of health benefits. + Decision making skills will be based upon the current needs… more
- Highmark Health (Concord, NH)
- …contribute to highest levels of performance. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities including, but limited to: involved in hiring and ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct, and control… more
- Highmark Health (Concord, NH)
- …with the Software Lifecycle + 3 years of Advanced domain experience **Preferred** + Utilization Management product experience highly preferred + 3 years with the ... + Business Acumen for P&Ls + Communication + Conflict Management **Language (Other than English):** None **Travel Requirement:** 0%...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Humana (Concord, NH)
- …+ Administer new innovative VBP models for range of provider types, such as behavioral health , maternity, specialists, and social determinants of health , ... **Become a part of our caring community and help us put health first** The Sr. Value-Based Programs professional supports successful value-based provider… more
- WellSense (Manchester, NH)
- …integrated, holistic person-centered care management interventions for a member's physical health , behavioral health (BH) and psychosocial support needs. ... on-going face-to-face comprehensive assessments with Member to evaluate member's medical, behavioral health , functional status, and socioeconomic needs +… more
- State of Massachusetts (Lawrence, MA)
- …requirements and regulations. . Participates in regular quality improvement and utilization management activities consistent with CBFS policy and practice. ... The Department of Mental Health (DMH) state operated program Respite and High...psychoeducation and skills training in areas such psychiatric illness management ; symptom reduction; dialectical behavioral support; trauma-informed… more
- Centerwell (Concord, NH)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... leader will play a critical role in ensuring optimal patient care, high quality health outcomes, and improved cost and utilization in pharmacy-related care, and… more