- Humana (Little Rock, AR)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work… more
- CVS Health (Harrisburg, PA)
- …or holidays. + 1+ years of utilization review / utilization management required. + 3+ years of behavioral health clinical experience in a hospital ... Experience** + **3 or more years BH clinical Experience** + **1 or more years Utilization Management Experience** + **Work at Home role. Can live Anywhere USA**… more
- Centene Corporation (Austin, TX)
- …day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with ... experience:** + Direct experience with Utilization Review or Utilization Management related to Behavioral Health case is preferred + Clinical… more
- Centene Corporation (Austin, TX)
- …experience is required. + Direct experience with Utilization Review or Utilization Management related to Behavioral Health case is preferred + ... accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to...preferred + Experience in Behavioral Health Case Management or Utilization Management in… more
- CVS Health (Phoenix, AZ)
- …partial hospitalization and intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior ... promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this… more
- Point32Health (MA)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the supervision of the Utilization Management Supervisor, the Behavioral Health (BH) ... and care management principles. Health Plan experience performing utilization review activities. Experience with McKesson's InterQual Clinical Screening… more
- UnityPoint Health (Cedar Rapids, IA)
- …ID: 174223 Overview This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient ... patient and provider satisfaction. The UM Specialist provides the Utilization Management function for patients admitted to...State of Iowa Licensed RN + Two years of behavioral health work experience. + Professional communication - written… more
- Molina Healthcare (Grand Rapids, MI)
- …and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to… more
- Immigration and Customs Enforcement (Washington, DC)
- …Perform other duties and responsibilities as assigned. 16. Utilization review / management for inpatient behavioral health hospitalization for IHSC. ... services include and are not limited to the following: case coordination/ management , monitoring high risk individuals, independent behavioral health reviews,… more
- Henry Ford Health System (Troy, MI)
- …implements and executes strategies for related to HAP's population health focus (care management , utilization management , behavioral health) to achieve ... and departmental goals and objectives between provider contracting, provider relationship management , medical directors and medical management to optimize… more
- Centene Corporation (Springfield, IL)
- …in various mental health settings especially inpatient behavioral health units, utilization management / review , and youth or pediatric services.** ... Additional Details: * Department: Illinois Utilization Management * Business Unit: Illinois Health...accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to… more
- Spectrum Billing Solutions (Skokie, IL)
- …Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist | UR Specialist | ... Review Specialist | ABA Utilization Review Specialist | ABA Utilization Management Specialist | ABA UR Specialist | Behavioral Health… more
- Molina Healthcare (Columbus, OH)
- …healthcare services professionals in some or all of the following functions: care management , utilization management , behavioral health, care ... of the following activities: care review , care management , utilization management (prior authorizations,...or more of the following areas: utilization management , care management , care transitions, behavioral… more
- AmeriHealth Caritas (Washington, DC)
- …meet the patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of ... **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity...the Medical Director for further review . The reviewer independently applies medical and behavioral health… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating care for members ... use of the member's benefit to provide the best quality care. The TeamThe RN Utilization Management Reviewer is part of a highly dedicated and motivated… more
- Molina Healthcare (AZ)
- …most effective setting while contributing to enterprise-wide strategies for integrated behavioral health programs, utilization management standardization, ... + Provides psychiatric leadership and clinical expertise for utilization management , case management , and integrated behavioral health/chemical… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Active clinical practice in order to participate in panel appeals + Experience in Utilization Management in a managed-care environment (as a clinician or in ... of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical...to evaluate clinical service requests + Practice anticipatory case management for members whose cases come for review… more
- Elevance Health (Atlanta, GA)
- …abuse cases preferred. **Preferred Skills, Capabilities and Experiences:** + Experience in behavioral health utilization management is highly preferred. + ... Behavioral Health Care Manager I- Behavioral ...there is licensed staff supervision. Previous experience in case management / utilization management with a broad… more
- Centene Corporation (Indianapolis, IN)
- …Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Elevance Health (CA)
- ** Behavioral Health Care Manager I, Utilization Management ** **Work Hours M-F 8am-5pm PST** **Work Location: Virtual, California** This role enables ... granted as required by law. The ** Behavioral Health Care Manager I, Utilization Management ** is responsible for managing psychiatric and substance abuse or… more
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