- Humana (Charleston, WV)
- …our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the ... health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work assignments are varied and… more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan is hiring a full-time Behavioral Health UM Care Manager to support our UM Clinical Operations team. This role will primarily work ... RN license. This role will review requests for authorization for behavioral health services. The Utilization Management ( UM ) Care Manager is responsible for… more
- CenterWell (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral … more
- CVS Health (Phoenix, AZ)
- …be at the forefront of clinical decision-making, applying your expertise in Behavioral Health to ensure members receive appropriate, evidence-based care. You'll ... **Position Summary** We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team....Apply critical thinking and evidence-based clinical criteria specific to Behavioral Health to evaluate inpatient and outpatient… more
- HCA Healthcare (Gainesville, FL)
- …to join an organization that invests in you as a Inpatient Authorization Review Services Behavioral Health Registered Nurse (RN) or Licensed Mental Health ... **Job Summary and Qualifications** The Inpatient Authorization Review Services Behavioral Health Registered Nurse or...which may include and not be limited to payer UM Manual, policy and procedure, facility contract information. +… more
- Centene Corporation (Springfield, IL)
- …in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of ... licensure as outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and ability to review… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …those with varied clinical expertise (ex. Social Work, Behavioral Health , Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, ... care cost drivers. Essential Accountabilities: Level I + Handles behavioral health member clinical management programs. +...Certification required + Broad understanding of multiple areas (ie UM and CM). At this level, incumbent is required… more
- Brighton Health Plan Solutions, LLC (NC)
- …criteria sets * Experience with both inpatient and outpatient reviews including Behavioral Health , DME, Genetic Testing, Clinical Trials, Oncology, and/or ... Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in...URAC and NCQA. * 2+ years' experience in a UM team within managed care setting. * 3+ years'… more
- CVS Health (Atlanta, GA)
- …+ This position may support UM (includes expedited), MPO, Coding, or Behavioral Health appeals. + This is a full-time telework position with standard ... At CVS Health , we're building a world of health...**Position Summary** CVS Aetna is seeking a dedicated **Appeals Nurse Consultant** to join our remote team. In this… more
- Humana (Providence, RI)
- …of contact for the beneficiary for all activities within the medical and behavioral health spectrum. They will also coordinate with other Medical Management ... part of our caring community and help us put health first** The Telephonic Nurse Case Manager...(SDOH). Plan shall include psychosocial issues, home environment and behavioral health needs across the full continuum… more
- Highmark Health (Jackson, MS)
- …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...in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced training and… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : University Hospital (9C Adult Psychiatry Unit) Apply Now **Job Summary** The Adult Inpatient Psychiatry Unit (9C) offers inpatient diagnostic ... both patients and families. **Mission Statement** Michigan Medicine improves the health of patients, populations and communities through excellence in education,… more
- US Tech Solutions (Columbia, SC)
- …+ Experience with prior insurance, utilization management, case management, surgical or behavioral health experience. This role conducts reviews of previously ... and procedures, while adhering to confidentiality regulations regarding protected health information. + Performs appeal and retrospective reviews demonstrating… more
- Saint Francis Health System (Tulsa, OK)
- …the level of care utilization. Assures compliance with Managed Care Behavioral Health standards in the area of UM procedures and documentation to permit ... therefrom or Master's degree in Social Work, Counseling or related behavioral health field. Licensure, Registration and/or Certification: Valid multi-state… more
- HCA Healthcare (Englewood, CO)
- …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 ... Swedish, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The...licensure in the State of Colorado as a Registered Nurse , or current active multistate nursing licensure, or LCSW… more
- Molina Healthcare (NM)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... Medicaid recipients. Preference will be given to those whose UM experience is within another MCO like Molina; experience...field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required… more
- AmeriHealth Caritas (Philadelphia, PA)
- …managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover ... Your career starts now. We're looking for the next generation of health care leaders. At AmeriHealth Caritas, we're passionate about helping people get care, stay… more
- HCA Healthcare (Englewood, CO)
- …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 ... Swedish, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The...licensure in the State of Colorado as a Registered Nurse , or current active multistate nursing licensure, or LCSW… more
- Elevance Health (Los Angeles, CA)
- …Medical terminology training and experience in medical or insurance field preferred. + Behavioral Health related knowledge is preferred. + For URAC accredited ... requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data...identification and data entry of referral requests into the UM system in accordance with the plan certificate. +… more
- Corewell Health (Grand Rapids, MI)
- …reviews and appeals. Additional support to the UM functions of the Corewell Health South Behavioral Health Inpatient unit. + Assesses internal and ... and makes recommendations to PCPs, specialists and other members of the health care team regarding care management strategies, identifying strategies to maximize… more