- Humana (Annapolis, MD)
- …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… more
- Elevance Health (Hanover, MD)
- …abuse cases preferred. **Preferred Skills, Capabilities and Experiences:** + Experience in behavioral health utilization management is highly ... Behavioral Health Care Manager I- ... Behavioral Health Care Manager I- Behavioral ...there is licensed staff supervision. Previous experience in case management / utilization management with a broad… more
- Evolent (Annapolis, MD)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Highmark Health (Annapolis, MD)
- …coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Elevance Health (Hanover, MD)
- …medical benefits, including medical management . **Hours: 8am-5pm (Local time)** The ** Behavioral Health Care Manager I** is responsible for managing adult ... ** Behavioral Health Care Manager I -...** Behavioral Health Care Manager I - Ameriben** **Location** :...Skills, Capabilities and Experiences:** + Previous experience in case management / utilization management with a broad… more
- Johns Hopkins University (Baltimore, MD)
- …enrollment and appointments for specialty substance use services and behavioral health care. + Manage tracking and utilization of resources. + Register ... Medicine is seeking a full time **_Substance Use & Behavioral Health Linkage_** . Under the direct...organized and detail oriented. + Excellent organizational and time management skills. + Independent and self-motivated. + Ability to… more
- WellSpan Health (York, PA)
- …as required. + Develops and initiates educational programs regarding utilization management principles. **Qualifications** **Minimum Education:** + Bachelors ... type assignment or Care Continuation Team (CCT) model (Case Management Nurse and Social Worker teams are assigned to...250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and… more
- Highmark Health (Annapolis, MD)
- …This role supports the full application product lifecycle for **clinical and utilization management software** , with a specific focus on driving ... function as a pivotal bridge, translating high-level **clinical and utilization management software** business needs into detailed...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Annapolis, MD)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- BrightSpring Health Services (Baltimore, MD)
- …pharmacy, home health care and primary care, and rehabilitation and behavioral health , we provide comprehensive and more integrated care and clinical ... utilization and hospital admission reduction. + Provides survey management support/ follow-up/and coordination of corrective actions plans relatied to care… more
- WellSpan Health (York, PA)
- …(BSN). Required **Work Experience:** + 2 years nursing experience and recent behavioral health experience required **Licenses:** + Licensed Registered Nurse Upon ... Life Support Upon Hire Required **Courses and Training:** + Certification in Behavioral Health Nursing Specialty Upon Hire Preferred **Knowledge, Skills, and… more
- Highmark Health (Annapolis, MD)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... decisions, ensuring alignment with the Quadruple Aim of Healthcare: lower per capita health care costs, improved outcomes and quality of care received, and optimal… more
- Highmark Health (Annapolis, MD)
- …residency program + 5 - 7 years in Pharmacy + 3 - 5 years in Pharmacist - Utilization Management + 3 - 5 years in Pharmacist - Medical Therapy Management ... are transitioned to a Pharmacist for Case & Disease Management (CMDM). The incumbent then conducts thorough research to...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- WellSpan Health (Hanover, PA)
- …Assists in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient ... providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland.… more
- Highmark Health (Annapolis, MD)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- WellSpan Health (York, PA)
- …providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. ... facilities to address some of the most complex medical, surgical and behavioral health conditions. WellSpan York Hospital's Regional Resource/Level 1 Trauma… more
- Johns Hopkins University (Baltimore, MD)
- …leadership team call schedule, which provides consultative support to the JHU Behavioral Health Crisis Support Team. **Specific Duties and Responsibilities** + ... and seminars. + Remains abreast of current literature and research on student behavioral health and evidence-based interventions. + Actively contributes to MHS… more
- Highmark Health (Annapolis, MD)
- …impact corporate performance + Researches, manipulates, and prepares data related to Health Management programs that document program activities and the results ... the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role...of Health Management… more
- CVS Health (Annapolis, MD)
- …. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health /Substance Abuse or Maternity/ Obstetrics experience.… more
- Johns Hopkins University (Baltimore, MD)
- …presenting concerns, performing a brief assessment of key mental and behavioral health indicators, and developing individualized treatment recommendations in ... assessments. + Remains abreast of current literature and research on student behavioral health and evidence-based intervention strategies, with a particular… more