- Humana (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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
- Humana (Santa Fe, NM)
- …+ 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 (Santa Fe, NM)
- …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
- LifePoint Health (Las Cruces, NM)
- …Professional Development and Growth Opportunities o And much more *Position Summary* Behavioral Health Therapist provides psychiatric assessment and therapy to ... diagnostic reasoning, clinical decision making, patient/family education, consultation, counseling, utilization management , and discharge planning. *_Minimum Qualifications_*_… more
- Humana (Santa Fe, NM)
- …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
- Molina Healthcare (Albuquerque, NM)
- …Molina's Behavioral Health function provides leadership and guidance for utilization management and case management and quality programs for mental ... and chemical dependency services and assists with implementing integrated Behavioral Health care management programs....for utilization management and case management programs for mental health and chemical… more
- Highmark Health (Santa Fe, NM)
- …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
- Centene Corporation (Santa Fe, NM)
- …management and/or utilization management experience. Experience in psychiatric health care settings, behavioral health conditions and members with ... functioning and wellness by ensuring consistent, timely access to medically necessary behavioral health services. Monitor quality of care, assist with discharge… more
- Magellan Health Services (Albuquerque, NM)
- …in healthcare, behavioral health , psychiatric and/or substance abuse health care setting. Strong organization, time management and communication skills. ... Knowledge of utilization management procedures, mental health and substance abuse community resources and providers. Knowledge and experience in inpatient… more
- Magellan Health Services (Albuquerque, NM)
- …the management , direct supervision and coordination of clinical and/or nonclinical management staff, including utilization management and intensive care ... staff, providing expertise in designated programs. + Assists clinical management in the development and on-going management ...and providers. Thorough knowledge of healthcare services in physical health , behavioral health or other… more
- LifePoint Health (Las Cruces, NM)
- …utilizes hospital resources in the development of care, discharge planning and Utilization Review. * Utilization Management performs prospective, admissions, ... observation and concurrent review according to standard policies and procedure. * Utilization Management reviews and analyze processes designed to ensure… more
- Highmark Health (Santa Fe, NM)
- …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
- Magellan Health Services (Las Vegas, NM)
- …team members as appropriate. + Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive ... or relevant experience in lieu of degree., Experience in utilization management , quality assurance, home or facility...management , quality assurance, home or facility care, community health , long term care or occupational health … more
- Magellan Health Services (Albuquerque, NM)
- …concepts, methods, and activities for unlicensed teams. Builds successful relationships with behavioral health providers, physical health partners, community ... and managing care coordination for those members meeting level II or level III behavioral health needs. Oversee program functions such as timeliness of followup… more
- Magellan Health Services (Albuquerque, NM)
- …for non-licensed care coordinators. + Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive ... Magellan Credentialing criteria. 2+ years' post-licensure clinical experience. Experience in utilization management , quality assurance, home or facility care,… more
- Humana (Santa Fe, NM)
- …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
- Highmark Health (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …+ 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