- Humana (Oklahoma City, OK)
- …a part of our caring community and help us put health first** The Manager , Utilization Management Behavioral Health utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Behavioral Health works within… more
- Elevance Health (Middletown, NY)
- …face-to-face onboarding and skill development. **Shift:** Monday- Friday 8:30-5:00 The Behavioral Health Care Manager ( UM ) job progression is primarily a ... analytics to improve the delivery of care. **Title** : Behavioral Health Care Manager - Utilization...if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral… more
- Magellan Health Services (Honolulu, HI)
- …LCSW, LSW, LPC or RN. Minimum 2 years experience post degree in healthcare, behavioral health , psychiatric and/or substance abuse health care setting. Strong ... the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or...quality of care. General Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote… more
- Highmark Health (Carson City, NV)
- …panel. Provides oversight over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of ... various resources to assist members in achieving their personal health goals. Will work with providers to insure quality...and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create… more
- Omaha Children's Hospital (Omaha, NE)
- **Now hiring for the region's first-of-its-kind Behavioral Health & Wellness Center. A place where innovation meets compassion.** **Positions are anticipated to ... our patients and families-from primary and specialty care to behavioral health services and everything in between....and processes. Communicates and collaborates with the Utilization Management ( UM ) Nurse, or other NCMs as necessary to provide… more
- Elevance Health (New Hyde Park, NY)
- …autism and depression, and insightful analytics to improve the delivery of care. **Title:** Behavioral Health Case Manager II **Candidates must posses a New ... EST **Build the Possibilities. Make an extraordinary impact.** The Behavioral Health Case Manager II...healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Conducts assessments to… more
- Excellus BlueCross BlueShield (Rochester, NY)
- … health care cost drivers. Essential Accountabilities: Level I * Handles behavioral health member clinical management programs. * Maintains knowledge of ... health care services. Examples may include Utilization Management, Quality, Behavioral Health , Pharmacy, Registered Dietitian and Respiratory Therapist *… more
- Excellus BlueCross BlueShield (Rochester, NY)
- … health care services. Examples may include: Utilization Management, Quality, Behavioral Health , Pharmacy, Registered Dietitian and Respiratory Therapist + ... Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health , Respiratory Therapy, Registered Dietitian, Registered Nurse,… more
- Independent Health (Buffalo, NY)
- …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...management, and/or quality improvement activities preferred. + Certified Case Manager (CCM) preferred. + Excellent knowledge base of community… more
- The Arora Group (Bethesda, MD)
- …Management/Utilization Management (RM/ UM ) experience. + Clinical subspecialty experience in Behavioral Health (2-5 years current experience). + Knowledge of ... Registered Nurse Case Manager Nurse Currently recruiting a Registered Nurse (RN)...for tracking and monitoring active duty cases admitted for behavioral health issues, alcohol and drug related… more
- Beth Israel Lahey Health (Burlington, MA)
- …making a difference in people's lives.** Manages the Utilization Management ( UM ) team, maintaining effective and efficient processes for determining appropriate ... regulatory and reimbursement requirements of various commercial and government payers. Manages UM department in the context of other Revenue Cycle functions such as… more
- Covenant Health (Nashua, NH)
- …Manager works closely with, and delegates care to, the High-Risk Social Worker/ Behavioral Health Clinician because of assessment and determination of social ... to receive services. + Delegates cases to High-Risk Social Worker/ Behavioral Health Clinician based on assessment including...and quality of care and communicates findings to the manager of the department. + Maintains current knowledge of… more
- Sharp HealthCare (San Diego, CA)
- …Sharp Health Plan's (SHP) physicians (Medical Directors (both medical and behavioral health ) and the Physician Reviewers) to coordinate the necessary ... co-management of our members related to their medical, behavioral health and pharmacy needs. This position...needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its'… more
- Elevance Health (Miami, FL)
- … health care program in which members' needs are identified, including physical health , behavioral health , social services for a special product/programs ... and oversees program operations in support of corporate and health plan UM management. + Directs and...and Experiences:** + Service delivery coordination, discharge planning, or behavioral health experience in a managed care… more
- AmeriHealth Caritas (Manchester, NH)
- …internal cross-functional teams, including network, member engagement, behavioral health , vendor management, utilization management ( UM ), care management ... managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover… more
- Commonwealth Care Alliance (Boston, MA)
- …that researches, analyzes, develops and disseminates medical policies pertaining to medical and behavioral health services (eg procedures, DME, Part B drugs) ) ... Manager , Medical Policy reports to the Director of UM , and manages the personnel and work of the...and services addressing social determinants of health across all products and geographies in collaboration with… more
- HCA Healthcare (Lake City, FL)
- …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 ... opportunity to make a real impact. As a(an) Case Manager RN PRN you can be a part of...a concurrent basis. + Identifies appropriate delays in the health care process and documents in the UM… more
- Highmark Health (Des Moines, IA)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of ... appropriateness of health care services, application of criteria to ensure appropriate...industry and corporate standards and are within the care manager 's professional discipline. + Function in accordance with applicable… more
- UPMC (Erie, PA)
- UPMC Community Care Behavioral Health is hiring a Clinical Manager for the Care Management team in Erie, PA! This position will work standard business hours ... travelling in the community and working remotely. The Clinical Manager is responsible for supervising the day-to-day operations of...related field + 5 years progressive management experience in behavioral health + Strong background in managed… more
- Highmark Health (Providence, RI)
- …this strategy, including retail and mail network optimization, rebate, formulary & UM financial optimization, and additional programs to meet segment growth and ... management, rebate contracting opportunities, and pharmacy programs (network, formulary, UM , buy-up's) to achieve segment specific pharmacy enrollment and financial… more