- Humana (Montpelier, VT)
- **Become a part of our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral ... health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the… more
- Highmark Health (Montpelier, VT)
- …**JOB SUMMARY** This role supports the Medical Policy team by bringing medical director level expertise, experience and knowledge to the team. They support ... the full-cycle ownership of commercial and Medicare Advantage medical policies, both developed internally and by vendors. This...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Montpelier, VT)
- …Patient care (hospital, outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed ... current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and… more
- CenterWell (Montpelier, VT)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... part of our caring community and help us put health first** The Associate Director , Product Management...or in-practice role (eg, Center Administrator, Front Office, Scheduling, Medical Assistant, Physician, or Physician Extender). + Two or… more
- Highmark Health (Montpelier, VT)
- …and lines of business. This will require aligning new models to the health plan's strategic objectives based on a deep understanding of innovation and industry ... Analytics, Contracting, Market and Provider support teams, Actuary, Finance, Highmark Health Solutions, Health Plan Operations. **ESSENTIAL RESPONSIBILITIES** +… more
- American Express Global Business Travel (Montpelier, VT)
- …offer an inclusive and collaborative culture where your voice is valued. The Director of GTM Analytics is a strategic, high-visibility leader responsible for driving ... across Marketing, Commercial and Decision Analytics to translate segmentation and behavioral insights into actionable targeting strategies across the full bowtie… more
- Humana (Montpelier, VT)
- …participates with facility discharge planners, Care Coordinators/Care Managers and the behavioral health personnel in coordinating the member's discharge needs. ... Duties and Responsibilities:** + Review PA requests for home health services, durable medical equipment, outpatient therapies,...specifying rational for approval, or for forwarding to the CMO/ Medical Director for further review. + Create… more
- Evolent (Montpelier, VT)
- …as required. + Entering data into a proprietary system generating cases for both the medical and behavioral health reviewers. These requests may be submitted ... also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our... reviews: LVNs, LPNs, and RNs along with our behavioral health reviewers: LMSWs, LCSW, and LPCs,… more