- Humana (Springfield, IL)
- …us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional who utilizes ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- Humana (Springfield, IL)
- …administration and strategic management of behavioral and physical health services, including Utilization Management (UM), Quality Improvement, and ... specialists + Develops comprehensive care programs for the management of adult behavioral health ...Management (QM) program; and work closely with the Utilization Management (UM) of services and associated… more
- Humana (Springfield, IL)
- **Become a part of our caring community and help us put health first** The Behavioral Health Strategy Lead Behavioral Health Executive Leader (known ... to Humana as a Behavioral Health Strategy Lead role) is responsible for defining, implementing, and advancing the strategic vision of behavioral health … more
- Highmark Health (Springfield, IL)
- …:** **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 (Springfield, IL)
- …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 (Springfield, IL)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... processing of pre-certification requests for authorization of medically necessary health care services, at the appropriate level of care,...and management . + Route Cases Based on Established Guidelines. +… more
- CVS Health (Springfield, IL)
- …. 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
- Humana (Springfield, IL)
- … who will lead teams of nurses, care coordinators and behavioral health professionals responsible for care management . The Manager, Care Management , ... of staff including service performance and adherence to established utilization and care coordination benchmarks. **Use your skills to...or more years of professional experience working in the health care industry and/or in care management .… more
- Highmark Health (Springfield, IL)
- **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
- Highmark Health (Springfield, IL)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This role is responsible for designing, developing, implementing, supporting, and optimizing ... solutions, networks, and infrastructure. Ensure optimal technology selection, resource utilization , and seamless integration. + Utilize modeling tools to develop… more
- Highmark Health (Springfield, IL)
- …within the Scrum Master and PO CoE teams through coaching, performance management , and fostering collaboration. The manager provides **oversight for Scrum Masters** ... **leading the Agile Transformation** , including strategic planning, change management , stakeholder engagement, tracking transformation metrics, and fostering continuous… more
- Highmark Health (Springfield, IL)
- **Company :** Allegheny Health Network **Job Description :** Applicants must be authorized to work in the US independently. At this time, we do not offer visa ... of data, analyses, slides and preparation for CMS TEAMS and ED CT Utilization workgroups + Exposure to VBR work, including various programs, models, contracts, etc.… more
- Highmark Health (Springfield, IL)
- …**Preferred** + 5 years of experience with communications + 3 years of experience in Utilization Review + 3 years of experience in Account Support + 1 year of ... + In-depth knowledge of the pharmacy industry, including benefit design, formulary management , and pharmacy best practices. + Proven ability to interpret and analyze… more