- Commonwealth Care Alliance (Springfield, MA)
- …intensive care management and care delivery. Within the CIC Program, The Senior Clinician , Behavioral Health (SBHC) serves as a leader for behavioral health care ... influence the clinical outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment for behavioral health needs, and closing quality… more
- InterDent (Portland, OR)
- …region Organizational Support Partner with the Group President on contract review , provider agreements, and vendor partnerships Communicate regularly with clinical ... implement, and monitor clinical guidelines, quality improvement initiatives, and utilization management processes to enhance patient outcomes and optimize resource… more
- Commonwealth Care Alliance (Springfield, MA)
- …to influence the outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment and closing gaps in care through connecting patients ... services. The CHW will play an integral role supporting patients with frequent utilization of Emergency Departments and acute admissions with the goal of identifying… more
- Stony Brook University (Stony Brook, NY)
- …Required to perform Donor and Therapeutic Apheresis as assigned.. + Perform blood utilization quality assurance, donor related work as assigned. + Required to cover ... patient's condition and questions regarding patient care to Charge RN/ Clinician . + Develops and maintains current written plan of...or for a maximum of 90 days. An initial review of all applicants will occur two weeks from… more
- Commonwealth Care Alliance (Boston, MA)
- …skills to improve CCA enrollee outcomes by impacting care access and utilization , closing care quality gaps, and optimizing member connection to medical, behavioral ... an integral role in reducing high emergency department (ED) and inpatient utilization related to unmet social needs, including housing, food, community resources… more
- Alameda Health System (San Leandro, CA)
- …staff, visitors, and volunteers. 8. Assures that the facility complies with all utilization review and case management requirements of Alameda County, AHS, and ... experience in the field of Psychiatry with experience as a practicing clinician or clinical leader and substantial experience in an administrative capacity in… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …mental health and co-occurring psychiatric and substance abuse conditions. POSITION TITLE: Utilization Review Clinician PAY RANGE: LVN/LPT $31.50-37.50 Per ... monitor and optimize reimbursement for external reviewers/third party payers. The Utilization Review Clinician maintains knowledge of, participates… more
- Centene Corporation (Honolulu, HI)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... Remote Position. Must Reside in Hawaii Registered Nurse (RN) or Licensed Clinician Only. Must have a current state's license **Must have Behavioral Health… more
- Centene Corporation (San Diego, CA)
- …substance abuse addiction disorders experience is required. + Direct experience with Utilization Review or Utilization Management related to Behavioral ... or Remote - TX** **Position Purpose:** Performs a clinical review and assesses care related to mental health and...Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / Florida *...teams to review care services related to Applied Behavior Analysis Services… more
- Dignity Health (Los Angeles, CA)
- …(if Master's level), case management, treatment planning, psychotherapy (if Master's level), and utilization review . The Mental Health Clinician will operate ... **Job Summary and Responsibilities** The Mental Health Clinician provides high quality home/community-based mental health services for children and their families.… more
- CenterWell (Columbia, SC)
- …clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify ... of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and...and monitor clinical & financial performance and metrics + Review clinician schedules and incentive plans to… more
- CenterWell (Hampton, VA)
- …clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization . + Periodically review clinician charts to identify ... of health (SDOH) efforts, improving clinical outcomes and avoidable utilization . + Monitor and manage daily patient care and...and monitor clinical & financial performance and metrics. + Review clinician schedules and incentive plans to… more
- CenterWell (Jacksonville, FL)
- …clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify ... of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and...and monitor clinical & financial performance and metrics. + Review clinician schedules and incentive plans to… more
- CenterWell (Daytona Beach, FL)
- …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify ... and operational budgeting, and monitor clinical & financial performance and metrics. * Review clinician schedules and incentive plans to align with patient… more
- CenterWell (Arlington, TX)
- …clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify ... and operational budgeting, and monitor clinical & financial performance and metrics. + Review clinician schedules and incentive plans to align with patient care… more
- Molina Healthcare (WA)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Cedar Rapids, IA)
- …a medical unit or emergency room. Previous experience in ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (NM)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN (preferred) or LPN with a compact license who resides in New Mexico or Texas. This team ... field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or medical clinic… more
- Molina Healthcare (NM)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). NEVADA State Specific Requirements: Must… more
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