- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review SpecialistJob Description The Behavioral Health Utilization Review Specialist conducts ... comprehensive utilization management activities for behavioral health plan members. This role includes...LMHC). + Minimum of two years of experience in utilization review /case management. + At least one… more
- Baylor Scott & White Health (Dallas, TX)
- …+ Experience working with Substance use treatment experience and/or behavioral health treatment + Experience with Utilization Management for Substance use ... vary based on position type and/or level **Job Summary** Utilization Review Specialist conducts reviews and shares...quality. **Essential Functions of the Role** + Process all Behavioral Health and Substance Use Disorder authorizations… more
- Centene Corporation (Austin, TX)
- …CANDIDATE WILL HAVE BCBA CERTIFICATION **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate ... BH utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines +… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** The Sr Clinician, Behavioral Health Utilization Review will review behavioral ... behavioral health managed care preferred + Experience in behavioral health utilization review or medical necessity evaluation preferred… more
- Independent Health (Buffalo, NY)
- …benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Behavioral Health Utilization Review Clinician will primarily ... be responsible for managing behavioral health benefits through utilization management functions as...services requested for the diagnosis and treatment of members' health conditions, applying established clinical review criteria,… more
- Elevance Health (Seven Fields, PA)
- …and a minimum of 3 years' experience in quality improvement and/or behavioral health , risk management and/or utilization review in a managed care setting ... **JR152864 Behavioral Health Clinical Quality Audit Analyst...outreach interventions, provider education and outreach interventions, medical record review , focus studies and surveys. + Conducts quality of… more
- Sutter Health (Berkeley, CA)
- …staff changes, workload, or technical development)._ **DEPARTMENT REQUIRED EDUCATION** Department, Behavioral Health : Master's in Social Work or related field ... with hospital administration, medical staff, patient registration and representatives of review organizations and others to ensure effective utilization of… more
- Centene Corporation (Austin, TX)
- …LMHC license or have a compact RN license with previous behavioral health experience. **Position Purpose:** Performs a clinical review and assesses care ... accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH)...health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review… more
- Eastern Connecticut Health Network (Manchester, CT)
- …EXPERIENCE: + Minimum of ten (10) years of experience in the Behavioral Health field with Utilization Review required. + Must have experience in ... This position is responsible for maximizing access to inpatient behavioral health care and patient movement for...with Director of CAT, Nurse Managers, Crisis Services, and Utilization Review . Responsible for patient movement across… more
- Spectrum Billing Solutions (Skokie, IL)
- …conference reviews. Minimum requirements: + 3-5 years of experience in utilization review for behavioral health services. + Bachelor's or Master's ... for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing...(Word, Excel, billing software). + Understanding of mental and behavioral health treatment services. At Spectrum, you… more
- AdventHealth (Glendale Heights, IL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use...+ Associate's of Nursing Required + RN experience in behavioral health preferred + Must be able… more
- Pacific Medical Centers (Renton, WA)
- …ongoing + 5 years Clinical experience. + 2 years In a Behavioral Health setting. + Utilization review /case management. **Why Join Providence?** Our ... Managed Care patient in order to assure cost effective, appropriate utilization of health care resource. Case Manager manages, directs, and coordinates the… more
- CVS Health (Frankfort, KY)
- …clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. ... /benefit management function. **Required Qualifications** + **_Kentucky Licensed Independent Behavioral Health Clinician (_** **_LPCC, LCSW, LMFT, LPAT_**… more
- CVS Health (Raleigh, NC)
- …operation and work schedules will include weekends, holidays, and evening hours._ As a Utilization Management Clinician - Behavioral Health you will utilizes ... and keyboarding + Must have active current and unrestricted Behavioral Health clinical licensure (LPC, LMSW, LSW,...and substance abuse disorders + Managed care experience + Utilization review experience + Crisis intervention skills… more
- Actalent (Sunrise, FL)
- Utilization Management Behavioral Health ClinicianUtilization Management Behavioral Health Clinician We're seeking a dedicated Behavioral ... this role, you'll collaborate with an interdisciplinary team to review and authorize behavioral health ...Conduct utilization reviews and service authorizations for behavioral health and substance use treatments. +… more
- Beth Israel Lahey Health (Burlington, MA)
- …making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient Registered Nurse (RN) Case ... Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality...review medical necessity and discharge planning) **As a health care organization, we have a responsibility to do… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Director of Utilization Review (UR) in a behavioral health setting oversees the UR process, ensuring appropriate and cost-effective care while ... with or without notice. Knowledge Skills and Abilities . Relevant experience in utilization management, behavioral health , or a related clinical setting.… more
- LifePoint Health (Louisburg, NC)
- Registered Nurse (RN) Utilization Review Job Type: Full Time | Day Your experience matters At Maria Parham Hospital, we are driven by a profound commitment to ... text outlines the responsibilities involved in monitoring adherence to the hospital's utilization review plan, which ensures the appropriate use of hospital… more
- HCA Healthcare (Nashville, TN)
- **Description** **Introduction** Do you have the career opportunities as a(an) Utilization Review Services RN you want with your current employer? We have an ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free...of colleagues. Do you want to work as a(an) Utilization Review Services RN where your passion… more
- AmeriHealth Caritas (Washington, DC)
- …Director for further review . The reviewer independently applies medical and behavioral health guidelines to authorize services, ensuring they meet the ... managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover… more