- Centene Corporation (New York, NY)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
- Atlantic Health System (Morristown, NJ)
- The Behavioral Health Clinician position in our Collaborative Care Program serves as an integrated member of the team at our Internal Medicine Faculty ... relapse prevention, and self-management strategies. 04. Provides brief, evidence-based behavioral interventions such as behavioral activation, cognitive behavior… more
- Highmark Health (Trenton, NJ)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more