- CVS Health (Raleigh, NC)
- …schedules will include weekends, holidays, and evening hours._ As a Utilization Management Clinician - Behavioral Health you will utilizes clinical ... and keyboarding + Must have active current and unrestricted Behavioral Health clinical licensure (LPC, LMSW, LSW,...Friday with flexible hours between 10:00am to 8:00pm EST. Utilization Management is a 24/7 operation and… more
- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... action. + Minimum one, (1) year of experience in Behavioral Health Nursing (inpatient outpatient, psych, substance...Nursing experience + Previous experience in utilization management with ASAM knowledge + Health Plan… more
- Evolent (Raleigh, NC)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Granville Health System (Oxford, NC)
- …case management tasks in the ED as well as within GHS. Behavioral Health responsibilities in this role may include: completing Psychosocial Assessments; ... one level of care to another using available resources. Job Functions 1. Provides behavioral health assessment, in partnership with the ED physician, to patients… more
- LifePoint Health (Louisburg, NC)
- …network committed to making communities healthier, with acute care, rehabilitation, and behavioral health facilities nationwide. From your first day to your ... Registered Nurse (RN) Utilization Review Job Type: Full Time | Day...days for patients. - Maintaining communication with the Case Management Department to facilitate timely discharge planning.. Reports to:… more
- UNC Health Care (Pittsboro, NC)
- …Experience Requirements:** An ideal candidate has direct experience in Primary Care Behavioral Health and crisis management . Experience in pediatric, ... communities we serve. Summary: Novel opportunity to help lead a new Primary Care Behavioral Health program at a Family Medicine and Pediatrics practice in… more
- Granville Medical Center (Oxford, NC)
- …case management tasks in the ED as well as within GHS. Behavioral Health responsibilities in this role may include: completing Psychosocial Assessments; ... one level of care to another using available resources. Job Functions 1. Provides behavioral health assessment, in partnership with the ED physician, to patients… more
- UNC Health Care (Smithfield, NC)
- …and well-being of the unique communities we serve. Summary: A Social Worker - Behavioral Health is an integral member of the healthcare team, providing ... and adhere to ethical guidelines **Job Details** Legal Employer: NCHEALTH Entity: Johnston Health Organization Unit: Behavioral Health Admin Work Type: Per… more
- Elevance Health (Raleigh, NC)
- …ensuring fidelity to the CFSP Care Management model which includes physical health , behavioral health , and social services. Primary duties may include, ... access to the same basic benefits and services, including Physical health , Behavioral health , Pharmacy,_ _Intellectual/Developmental_ _Disabilities (I/DD)… more
- CenterWell (Raleigh, NC)
- …engagement, improving provider capacity by reducing administrative work related to population health management , and assisting patients with the aim of improving ... advocate for improving clinician and patient experience and effectiveness through panel management (aka population health management ) + Comfortable managing… more
- Highmark Health (Raleigh, NC)
- …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...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- Elevance Health (Raleigh, NC)
- … under the CFSP Care Management model, including coordination across physical health , behavioral health , I/DD, LTSS, pharmacy, and unmet health ... have access to the same basic benefits and services, including Physical health , Behavioral health , Pharmacy, Intellectual/Developmental Disabilities (I/DD)… more
- City of Durham (Durham, NC)
- …Response Teams)-to meet the needs of people in crisis with compassionate care and behavioral health expertise. In the first twelve months of operation, and ... Familiarity with Durham health systems and community resources/services for physical health behavioral and mental health , substance use, Intellectual… more
- Highmark Health (Raleigh, NC)
- …(Claims, Dental Benefits, Customer Service, Membership & Billing), Provider Data Management , Underwriting, and Professional Relations. **This role will support the ... including gathering data from multiple sources related to Benefit/Claim Utilization , Enrollment, Networks ( utilization , disruption, geo-access) and making… more
- City of Durham (Durham, NC)
- …Response Teams)-to meet the needs of people in crisis with compassionate care and behavioral health expertise. In the first twelve months of operation, and ... clinicians into Durham's 911 call center to triage, assess, and respond remotely to behavioral health related calls that can be resolved over the phone. It… more
- Elevance Health (Durham, NC)
- …A proud member of the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health Options, offers superior clinical mental ... preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For… more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …social work values and ethics. The incumbent provides advance level medical, behavioral , and crisis intervention services to Veterans pre-screened by the Transfer ... Team or referred by colleagues. Functions: The incumbent provides medical and behavioral social work services for Veterans who are identified and referred by the… more
- Highmark Health (Raleigh, NC)
- …:** **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
- UNC Health Care (Chapel Hill, NC)
- …of patients based on various factors such as medical conditions, social determinants of health , and behavioral health needs. b. Develop strategies to ... 7. Payer Communication: a. Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely… more
- Highmark Health (Raleigh, NC)
- …and leadership from more senior Delivery Owners. The incumbent provides project management leadership and facilitates the delivery of system changes from approval ... through to release to production. The leadership provided includes all project management outputs as well as extensive communication with business stakeholders both… more