- Molina Healthcare (Long Beach, CA)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... Experience using PEGA Preferred License, Certification, Association Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE… more
- InterCommunity, Inc. (Hartford, CT)
- …practices) Ensures ASAM criteria is clearly documented within time frames and utilization review process is completed within time frames. Performs related ... (Sunday, Tuesday-Thursday 8am-4:30pm & Monday 10:30am-7pm). Summary: An experienced clinician who possesses knowledge about treatment of co-occurring disorders and… more
- American Traveler (Salem, MA)
- …inpatient medical/surgical setting with a 200-bed capacity, *Adult patient population with a clinician to patient ratio of 1:15, *Day shifts from 8:00am to 4:30pm ... through AHA required, *ACLS certification through AHA required, *Case Management, Utilization Management, and Discharge Planning skill set required, *Certified Case… more
- AmeriHealth Caritas Health Plan (Philadelphia, PA)
- …judgment, and meaningful collaboration. Lead with Clinical Insight. Whether you're an experienced utilization review nurse, a sharp case manager, or a behavioral ... Discover more about us at www.amerihealthcaritas.com. Join a mission-driven Utilization Management team where your clinical expertise helps shape...health clinician ready to make an impact behind the scenes,… more
- LHC Group, Inc. (Lafayette, LA)
- …electronic medical record to ensure accuracy of OASIS items, documentation, and utilization for quality and outcome management through clinician collaboration ... and/or per clinician and discusses with Clinical Director and Quality Review Supervisor to further train/educate staff and improve OASIS accuracy. Reports to… more
- Blue Cross and Blue Shield of Minnesota (Duluth, MN)
- …is a critical component of BCBSMN Care Management team as the primary clinician providing condition and case management services to members. The position exists to ... with psychiatric experience, or a Behavioral Health Professional who is a clinician licensed for independent practice in Minnesota with an active, unrestricted… more
- Integral Care (Austin, TX)
- …utilizing assessment, multidisciplinary coordination, and efficient clinically appropriate utilization of agency resources. Duties include collaboration with ... handled with considerable independence, and complicated cases receive closer clinical review and supervision. Services provided may include individual, family and/or… more
- Navvis (Corvallis, OR)
- …improve patient outcomes, reduce unnecessary care variation, reduce unnecessary utilization , and enhance care coordination. Ensuring delivery of optimal, medically ... Monitor key performance indicators (KPIs) related to quality, cost, and utilization across all value-based contracts. Lead efforts to analyze performance data,… more
- OptiMindHealth (Reading, MA)
- …Part-Time FLSA Status: Non-Exempt Location: Reading , MA Join a leading clinician -led behavioral health company today! OptiMindHealth (OMH) is expanding and seeking ... Discuss the possible overlap in our offerings and needs to stakeholders, review our specialty areas and note our differentiating characteristics. 3. Complete and… more
- SpringHealth Behavioral Health and Integrated Care (San Antonio, TX)
- …all updates to State and Federal Regulations regarding services provided In-service behavior clinician (s) on all changes made to regulations. Review all billing ... and professional teams. Provide staff/family training on implemented programs. Review all Functional Behavior Assessments/Behavior Support Plans prior to… more
- Lorenz Clinic (Wayzata, MN)
- …refill requests from client and/or pharmacies and prepares them for prescribing clinician review . Reviewing each patient's chart for recent psychiatry notes ... reported responses and/and or side-effects to medications and treatments including utilization of standardized tools such as the Assessment for Involuntary Movements… more
- Kaiser Permanente (Pleasanton, CA)
- …assure continuity and quality of care. Attends case management rounds with clinician and updates authorizations and diagnoses as needed. Assesses patient progress ... Provides services related to patient disposition by: performing daily review for early identification of disposition planning activities; developing, evaluating,… more
- Connections Health Solutions (Woodbridge, VA)
- …risk assessment, and discharge planning. Serves as the attending clinician to specified individuals. Completes initial psychiatric assessments, crisis interventions, ... team. Provides necessary information to clinical team regarding inpatient utilization . Utilizes appropriate medication based on best practices. Collaborates with… more
- Monte Nido (Miami, FL)
- …save lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician ** **Monte Nido** **Remote - EST or CST ... to provide comprehensive care within an intimate home setting. The Utilization Review ** Clinician ** is responsible for conducting daily administrative and… 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
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** The Sr Clinician , Behavioral Health Utilization Review will review behavioral health and ... in behavioral health managed care preferred + Experience in behavioral health utilization review or medical necessity evaluation preferred **Required Knowledge,… more
- Centene Corporation (Raleigh, NC)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… 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 ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more
- Eastern Connecticut Health Network (Manchester, CT)
- …clinical information and disseminates to the interdisciplinary treatment team. + Contacts Utilization Review clinician with authorization and follow up ... works in collaboration with Director of CAT, Nurse Managers, Crisis Services, and Utilization Review . Responsible for patient movement across the system. Assists… 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
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