- Humana (Austin, TX)
- …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
- Centene Corporation (Austin, TX)
- …appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization ... + Direct experience with Utilization Review or Utilization Management related to Behavioral Health case is preferred + Clinical knowledge and ability… more
- Centene Corporation (Austin, TX)
- …is required. + Direct experience with Utilization Review or Utilization Management related to Behavioral Health case is preferred + Clinical ... inpatient hospital experience is preferred + Experience in Behavioral Health Case Management or Utilization Management in Managed Care Organizations,… more
- Molina Healthcare (Austin, TX)
- …chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and ... and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and… more
- Centene Corporation (Austin, TX)
- …for our 28 million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified, national organization offering ... year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time… more
- Molina Healthcare (Austin, TX)
- …while contributing to enterprise-wide strategies for integrated behavioral health programs, utilization management standardization, and cost-effective ... psychiatric leadership and clinical expertise for utilization management , case management , and integrated behavioral health /chemical dependency… more
- Molina Healthcare (Austin, TX)
- …professionals in some or all of the following functions: care management , utilization management , behavioral health , care transitions, long-term ... Job Duties * Assists in implementing health management , care management , utilization management , behavioral health and other program… more
- Centene Corporation (Austin, TX)
- … Health goals for the product. + Take a macro-level view of behavioral health utilization management responsibilities to optimize clinical resource ... Provides strategic and clinical leadership for Behavioral Health across all clinical functions ( Utilization Management , Care Management , Quality, and… more
- CVS Health (Austin, TX)
- …applicants whose only acute care experience is in behavioral health ) **Preferred Qualifications** + 1+ years' experience Utilization Review experience ... At CVS Health , we're building a world of health...Job Description Primary Job Duties & Responsibilities Drives effective utilization management practices by ensuring appropriate and… more
- CVS Health (Austin, TX)
- …applicants whose only acute care experience is in behavioral health ) **Preferred Qualifications** + 1+ years' experience Utilization Review experience ... At CVS Health , we're building a world of health...with heart, each and every day. **Position Summary** This Utilization Management (UM) Nurse Consultant role is… more
- CVS Health (Austin, TX)
- …issues. * Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the ... care issues through established channels * Ability to speak to medical and behavioral health professionals to influence appropriate member care. * Utilizes… more
- Humana (Austin, TX)
- …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
- Molina Healthcare (Austin, TX)
- …or more of the following areas: utilization management , care management , care transitions, behavioral health , or equivalent combination of relevant ... Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification. * Leadership experience. *… more
- Highmark Health (Austin, TX)
- …:** **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 (Austin, TX)
- …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 (Austin, TX)
- …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 (Austin, TX)
- …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 (Austin, TX)
- …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 (Austin, TX)
- …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 (Austin, TX)
- …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