- CVS Health (Oklahoma City, OK)
- …+ Managed care/ utilization review experience preferred + Experience in a behavioral health inpatient setting + Ability to multitask, prioritize and ... every day. **_Work at home Position-Must Reside in Oklahoma_** **Position Summary: Behavioral Health Clinical Reviewer (LCSW, LCPC, RN)** Licensed clinical… more
- CVS Health (Oklahoma City, OK)
- …stakeholders to identify and address patient needs (eg care team, social work, behavioral health , utilization management , Hard-to-Reach, Central ... follow-up care, and next steps. + Coordinate with the Utilization Management team to review medical and...we looking for?** **Required Qualifications** + Active RN or Behavioral Health (BH) license in good standing… more
- CVS Health (Oklahoma City, OK)
- …working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal departments. + ... management program. + Conduct clinical reviews for adult inpatient behavioral health cases, applying established medical necessity criteria to ensure… more
- Humana (Oklahoma City, OK)
- …value-based care, quality metrics, population health , and disease or care management . The Behavioral Health Medical Director may develop procedures, ... part of our caring community and help us put health first** The Behavioral Health ...management , utilization management , case management , discharge planning and/or home health or… more
- CVS Health (Oklahoma City, OK)
- …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 (Oklahoma City, OK)
- …:** **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 (Oklahoma City, OK)
- …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 (Oklahoma City, OK)
- …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 (Oklahoma City, OK)
- …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 (Oklahoma City, OK)
- …state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health Plan / Payor ... and New Jersey** offering a variety of physical and behavioral health programs and services to its...can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will… more
- CVS Health (Oklahoma City, OK)
- …. 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
- Sharecare (Oklahoma City, OK)
- …members to become empowered and active participants in their own healthcare management for their chronic condition. By providing health education and ... **Job Description:** Sharecare is the leading digital health company that helps people - no matter...nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management… more
- Highmark Health (Oklahoma City, OK)
- …of internal clinical and value-based evaluation committees that drive formulary and utilization management functions. + Participate in product specific Pharmacy ... value of implemented initiatives. + Lead product based pharmacy trend management discussions with internal partners including senior executives. + Support… more
- Highmark Health (Oklahoma City, OK)
- …terms through regular on-site audits. Apply an active role in network management , training, monitoring and enforcement of company policies and procedures while ... confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.… more
- Highmark Health (Oklahoma City, OK)
- …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
- Highmark Health (Oklahoma City, OK)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job plays a key role in ensuring projects (ie change initiatives) meet objectives on time ... and minimize risk to implementation. Works to drive faster adoption, higher ultimate utilization and greater proficiency of the changes that impact employees in the… more
- CVS Health (Oklahoma City, OK)
- …specifically Excel, Outlook, and Word. **Preferred Qualifications** + Previous experience in behavioral health . + Previous experience in the medical or insurance ... At CVS Health , we're building a world of health...calls to providers and members, as well as facilitating utilization of the Employee Assistance Program ( _EAP_ )… more
- Highmark Health (Oklahoma City, OK)
- …AI techniques, assessing their applicability to core healthcare payer operations (eg, utilization management , claims processing, member services). 3. Modeling & ... **Company :** Highmark Health **Job Description :** **SUMMARY OF JOB RESPONSIBILITIES**...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- CenterWell (Oklahoma City, OK)
- …**Additional Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization review ... a focus on collaborative business relationships, value-based care, population health , or disease or care management . **Use...and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral … more
- Humana (Oklahoma City, OK)
- …+ Administers new innovative VBP models for range of provider types, such as behavioral health , maternity, specialists, and social determinants of health , ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Senior...move providers from volume to value. + Analyzes financial, utilization , and performance data to identify opportunities to drive… more