- Humana (Hartford, CT)
- …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
- Evolent (Hartford, CT)
- …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 (Hartford, CT)
- …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
- Hartford HealthCare (Hartford, CT)
- …balance. Every moment matters. And this is *your moment*. **Job:** ** Behavioral Health * **Organization:** **Hartford HealthCare Medical Group Specialists* ... **Title:** *Licensed Clinician ( LCSW, LPC, LMFT, LADC) - Trinity College Behavioral Health - 10 months * **Location:** *Connecticut-Hartford-300 Summit Street… more
- Highmark Health (Hartford, CT)
- …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 (Hartford, CT)
- …:** **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
- Hartford HealthCare (Bloomfield, CT)
- …medical providers, brief and evidence-based treatments for behavioral and mental health issues, * Effective utilization of screening measures and assessment ... Health Center offers a holistic approach to the management of this unique patient population with the integration...journal clubs. Additionally, the psychologist will interface with other behavioral health specialists within and outside the… more
- Highmark Health (Hartford, CT)
- …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 (Hartford, CT)
- …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 (Hartford, CT)
- …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 (Hartford, CT)
- …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
- Moses/Weitzman Health System (Hartford, CT)
- …the country's most creative and dynamic providers of primary medical, dental, and behavioral health services, and a leader in practice-based research, health ... client's health care needs. Participates with Community Health Center management in developing and achieving...for quality. We employ several hundred medical, dental, and behavioral health providers who are engaged in… more
- Highmark Health (Hartford, CT)
- …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
- Highmark Health (Hartford, CT)
- …supporting, and optimizing the architectural strategy for **all clinical and utilization management applications** . Their expertise spans application, solution, ... and AI integration, extending this strategic oversight across **all clinical and utilization management applications** . This involves ensuring the completeness… more
- Wondr Health (Hartford, CT)
- …**Full** **-Time, Exempt** **COMPANY OVERVIEW** **:** Wondr HealthTM is a digital behavioral change program focused on weight management , that helps participants ... tools. By treating the root cause of obesity through behavioral science, Wondr reduces risk factors to prevent chronic...and mental wellbeing. A master class of sorts, Wondr Health 's team of renowned doctors and scientists teaches practical,… more
- Highmark Health (Hartford, CT)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...measurable outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and… more
- The Cigna Group (Bloomfield, CT)
- …external customers. He/she will serve as a clinical educator and consultant to utilization management , case management , network, contracting, pharmacy, and ... novel treatments, to support high-quality clinical decision-making across medical and behavioral health conditions, diseases, treatments, and procedures. Medical… more
- Highmark Health (Hartford, CT)
- …and mentorship in areas of expertise and architecture to peers, developers, management , and business users. **Key Responsibilities:** + Lead the design and ... application designs to ensure optimal technology selection, efficient resource utilization , and seamless system integration. + Ensure system architecture adheres… more
- Highmark Health (Hartford, CT)
- **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 (Hartford, CT)
- …Provide analytical/strategic-thinking and leadership support that enables the medical policy and utilization management teams to: 1) isolate business issues; 2) ... to junior team members; Provide performance input and recommendations to management for development/ training plans. May have supervisory responsibilities on a… more