- Humana (Richmond, VA)
- …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 (Richmond, VA)
- ** Behavioral Health Care Manager II -...is licensed staff supervision. + Previous experience in case management / utilization management with a broad ... the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health ...Beacon Health Options, offers superior clinical mental health and substance use disorder management , a… more
- Elevance Health (Richmond, VA)
- ** Behavioral Health Medical Director-Psychiatrist Appeals** **Location:** This role enables associates to work virtually full-time, with the exception of ... Monday - Friday. Half day Saturday rotation, once a month.** The ** Behavioral Health Medical Director-Psychiatrist Appeals** is responsible for the… more
- Humana (Richmond, VA)
- …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
- Elevance Health (Richmond, VA)
- …Medical Management of more than one member population type of Physical Health and/or Behavioral Health with varying degrees of medical complexity. ... you will make an impact:** + Oversees case and utilization management execution/decision making for managed member... management . + Partners with Provider Relations, Quality Management , Health Promotions, and Community Relations to… more
- CVS Health (Richmond, VA)
- …acknowledges physicians for their clinical excellence and effective utilization of health care resources. Reporting to the Executive Behavioral Health ... members across Aetna. **Expectations and Responsibilities:** * Serve as the principal utilization management reviewer for cases related to Applied Behavior… more
- Highmark Health (Richmond, VA)
- …:** **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 (Richmond, VA)
- …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 (Richmond, VA)
- …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 (Richmond, VA)
- …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 (Richmond, VA)
- …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
- Highmark Health (Richmond, VA)
- …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 (Richmond, VA)
- …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 (Richmond, VA)
- …. 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
- Elevance Health (Henrico, VA)
- …identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term ... chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. + Obtains a thorough and accurate… more
- Highmark Health (Richmond, VA)
- …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 (Richmond, VA)
- …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
- Wondr Health (Richmond, VA)
- …**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 (Richmond, VA)
- …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
- Elevance Health (Richmond, VA)
- …and other clients of the Carelon Services businesses, including behavioral health , medical benefits utilization management , specialty care solutions, and ... and legal colleagues to harmonize, centralize, and improve existing contract management workflows and policies across the Carelon Services businesses. + Become… more