- Humana (Annapolis, MD)
- …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
- Immigration and Customs Enforcement (Washington, DC)
- …Perform other duties and responsibilities as assigned. 16. Utilization review/ management for inpatient behavioral health hospitalization for IHSC. ... Summary The Behavioral Health Case Manager is a...case coordination/ management , monitoring high risk individuals, independent behavioral health reviews, behavioral … more
- Elevance Health (Washington, DC)
- …abuse cases preferred. **Preferred Skills, Capabilities and Experiences:** + Experience in behavioral health utilization management is highly ... Behavioral Health Care Manager I- ... Behavioral Health Care Manager I- Behavioral ...there is licensed staff supervision. Previous experience in case management / utilization management with a broad… more
- AmeriHealth Caritas (Washington, DC)
- …products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more ... **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity...for further review. The reviewer independently applies medical and behavioral health guidelines to authorize services, ensuring… more
- Evolent (Washington, DC)
- …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
- Highmark Health (Washington, DC)
- …coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Elevance Health (Hanover, MD)
- …medical benefits, including medical management . **Hours: 8am-5pm (Local time)** The ** Behavioral Health Care Manager I** is responsible for managing adult ... ** Behavioral Health Care Manager I -...** Behavioral Health Care Manager I - Ameriben** **Location** :...Skills, Capabilities and Experiences:** + Previous experience in case management / utilization management with a broad… more
- Adecco US, Inc. (Dulles, VA)
- **Position Title:** Nurse Manager - Behavioral Health **Location:** 24440 Stone Springs Blvd, Dulles, VA 20166 **Facility:** StoneSprings Hospital Center ... fostering collaboration, compassion, and excellence in care. The Nurse Manager - Behavioral Health oversees the day-to-day operations of the Behavioral… more
- AmeriHealth Caritas (Washington, DC)
- …products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more ... **Responsibilities:** Responsible for managing the day-to-day activities of the Health DC Plan Network Management department and staff. Responsible for assisting… more
- Highmark Health (Washington, DC)
- …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 (Washington, DC)
- …:** **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
- Battelle Memorial Institute (Arlington, VA)
- …**Responsibilities** + Assist with the management and treatment of outpatient behavioral health activities + Under the supervision of a licensed ... working in a dynamic, mission-driven environment. This position supports outpatient behavioral health activities by conducting intake interviews, assisting with… more
- Highmark Health (Washington, DC)
- …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 (Washington, DC)
- …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 (Washington, DC)
- …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 (Washington, DC)
- …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 (Washington, DC)
- …. 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 (Washington, DC)
- …needs of members. **How you will make an impact:** + Implements and manages health care management , utilization , cost, and quality objectives. + Ensures ... The **HCMS Director** will be responsible for managing the utilization or care management process for one...for one or more member product populations of Physical Health and/or Behavioral Health of… more
- Highmark Health (Washington, DC)
- …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
- Elevance Health (Arlington, 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