- Humana (St. Paul, MN)
- …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
- Fairview Health Services (Minneapolis, MN)
- …and Quality named MHealth Fairview Clinics as one of eight "exemplar" integrated behavioral health primary care models across the country. Integrated care is ... the result of an engaged primary care team and Behavioral Health Clinician providing patient-centered care addressing...determinants of health , and ineffective patterns of health care utilization . At MHealth Fairview, integrated… more
- Fairview Health Services (Minneapolis, MN)
- …and Quality named MHealth Fairview Clinics as one of eight "exemplar" integrated behavioral health primary care models across the country. Integrated care is ... a result of an engaged primary care team and Behavioral Health Clinician providing patient-centered care addressing...determinants of health , and ineffective patterns of health care utilization . At MHealth Fairview, integrated… more
- Fairview Health Services (Edina, MN)
- …and Quality named MHealth Fairview Clinics as one of eight "exemplar" integrated behavioral health primary care models across the country. Integrated care is ... a result of an engaged primary care team and Behavioral Health Clinician providing patient-centered care addressing...determinants of health , and ineffective patterns of health care utilization . At MHealth Fairview, integrated… more
- Humana (St. Paul, MN)
- …clinical services . Experience in utilization management review and case management in a health plan setting . No current sanction from Federal or ... part of our caring community and help us put health first** The Behavioral Health ...a focus on collaborative business relationships, value-based care, population health , or disease or care management +… more
- Highmark Health (St. Paul, MN)
- …:** **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
- Highmark Health (St. Paul, MN)
- …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 (St. Paul, MN)
- …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 (St. Paul, MN)
- …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
- Highmark Health (St. Paul, MN)
- …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
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …and difficult issues sensitively */License/Certifications:/* *//*For employees working in a Behavioral Health Home certified clinic, employees must be certified ... of complex patients to facilitate the delivery of cost-effective health care and identify the appropriate utilization ...support specialist * Family peer support specialist * Case management associate * Mental health rehabilitation worker… more
- BrightSpring Health Services (St. Paul, MN)
- …Business SpringPath Mental Health Services, an affiliate of BrightSpring Health Services, assists individuals with emotional, behavioral , and psychiatric ... Our Company SpringPath Mental Health Services Overview This position oversees delivery of...Conduct weekly staff meeting for location + Utilize behavior management strategies + Ensures quality assurance including person served… more
- Highmark Health (St. Paul, MN)
- …to set health goals by working cooperatively with medical providers, case management departments and/or health plans to help ensure that patients have ... **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This...resources appropriate to the needs of patients/families and ongoing utilization of resource database. (5%) + Other duties as… more
- Highmark Health (St. Paul, MN)
- …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
- BrightSpring Health Services (Elk River, MN)
- …patients' expectations. From brain and spinal cord injuries to autism therapy and behavioral health , clinicians and therapists build a program around the patient ... organizing admissions and discharges + Conducting Assessments (Diagnostic, Level of Care Utilization System, Mental Health Review, Suicidal, and evaluation level… more
- Highmark Health (St. Paul, MN)
- …of various projects and data analysis related to Medical Policy and Utilization Management . **ESSENTIAL RESPONSIBILITIES** + Perform management ... a supervisory capacity or role **Preferred** + Experience in Utilization Management and/or Medical PolicyExperience working with...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (St. Paul, MN)
- …supporting, and optimizing the architectural strategy for **all clinical and utilization management applications** . Their expertise spans application, solution, ... and AI integration, extending this strategic oversight across **all clinical and utilization management applications** . This involves ensuring the completeness… more
- Fairview Health Services (Edina, MN)
- …for services provided + Completes the requirements of various payers and utilization management reviewers to obtain authorization for treatment. Demonstrates the ... relevant needs. Facilitates individual and group psychoeducation. + Focuses on the management of physical and mental health conditions. + Provides appropriate… more
- Wondr Health (St. Paul, MN)
- …**Full** **-Time, Exempt** **COMPANY OVERVIEW** **:** Wondr HealthTM is a digital behavioral change program focused on weight management , that helps participants ... tools. By treating the root cause of obesity through behavioral science, Wondr reduces risk factors to prevent chronic...and mental wellbeing. A master class of sorts, Wondr Health 's team of renowned doctors and scientists teaches practical,… more
- Highmark Health (St. Paul, MN)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...measurable outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and… more