- Humana (Nashville, TN)
- …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
- Highmark Health (Nashville, TN)
- …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 (Nashville, TN)
- ** Behavioral Health Medical Director-Psychiatrist Appeals** **Location:** This role enables associates to work virtually full-time, with the exception of ... Monday - Friday. Half day Saturday rotation, once a month.** The ** Behavioral Health Medical Director-Psychiatrist Appeals** is responsible for the… more
- Humana (Nashville, TN)
- …clinical services . Experience in utilization management review and case management in a health plan setting . No current sanction from Federal or ... part of our caring community and help us put health first** The Behavioral Health ...a focus on collaborative business relationships, value-based care, population health , or disease or care management +… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …+ Extensive knowledge of all aspects of Utilization Management , Care Management , and Behavioral Health \. + Knowledge and understanding of Medical ... the appropriate area\. Identify and refer cases appropriately to the Case Management and/or Transition of Care department\. + Receiving, investigating and resolving… more
- Elevance Health (Nashville, TN)
- …Medical Management of more than one member population type of Physical Health and/or Behavioral Health with varying degrees of medical complexity. ... you will make an impact:** + Oversees case and utilization management execution/decision making for managed member... management . + Partners with Provider Relations, Quality Management , Health Promotions, and Community Relations to… more
- Highmark Health (Nashville, TN)
- …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 (Nashville, TN)
- …:** **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 (Nashville, TN)
- …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 (Nashville, TN)
- …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 (Nashville, TN)
- …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
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... HCA offers a total rewards package that supports the health , life, career and retirement of our colleagues. The...supply chain operations. ii) Value Analysis iii) Clinical Resource Management Program iv) Product standardization and utilization … more
- Veterans Affairs, Veterans Health Administration (Memphis, TN)
- …serve as the subject matter expert for the discipline. Senior LPMHCs develop behavioral health related training curriculum and often conduct trainings for ... patients in a variety of treatment settings, including tele-mental health . Provide 24 Hours/7 Day on site mental ...times in the VHA Emergency Departments that have higher utilization , higher risk patients, specialized intensive care units, and… more
- Highmark Health (Nashville, TN)
- …to set health goals by working cooperatively with medical providers, case management departments and/or health plans to help ensure that patients have ... **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This...resources appropriate to the needs of patients/families and ongoing utilization of resource database. (5%) + Other duties as… more
- Highmark Health (Nashville, TN)
- …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
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... organization that invests in you as a Director Case Management ? At TriStar Skyline Medical Center, you come first....Center offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... within the group(s), including staffing, maintenance, repairs, parts, operations, fleet management and vendor/contractor utilization . + Responsible for the… more
- CVS Health (Nashville, TN)
- …. 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
- HCA Healthcare (Hendersonville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The...management . + Consults with facility-level staff regarding delegated utilization management and disease management … more
- HCA Healthcare (Nashville, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... years. **Benefits** HCA Healthcare offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and… more