- Elevance Health (Kailua, HI)
- …responsible for appeals reviews within our Medicaid and Medicare programs.** The ** Behavioral Health Medical Director** is responsible for the administration of ... behavioral health medical services, to ensure the...and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers… more
- Humana (Honolulu, HI)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post acute services such as ... part of our caring community and help us put health first** The Behavioral Health ...managers or Care managers on complex case management , including familiarity with social determinants of health… more
- Highmark Health (Honolulu, HI)
- …any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience ... health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member...of members in his/her panel that are enrolled in case management . The incumbent conducts outreach to… more
- Magellan Health Services (Schofield Barracks, HI)
- …Participate in relevant community awareness, campaigns and prevention events. + Maintain ongoing case management , all data entry must be completed within three ... school in social/work, psychology, marriage, family, and child counseling, counseling or behavioral science, education, community health or public health .… more
- Highmark Health (Honolulu, HI)
- …providers. + Maintain current case related information on all applicable case management tracking systems. + Provide investigative support and mentoring to ... law enforcement entities and work with those agencies through closure of the case . Conduct audits for proactive and investigative purposes to comply with internal… more
- Lumen (Honolulu, HI)
- …the world and shape the future. **The Role** The Sr. Manager Program Management role requires working collaboratively with leaders across the Lumen organization to ... efforts of varying size and complexity. This role will utilize change management principles, processes, and tools to focus on driving financial and operational… more
- CenterWell (Honolulu, HI)
- …care and high-risk management and care coordination. * Experience with case management , social work, skilled nursing facilities, rehab programs, etc. * ... that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more… more
- Highmark Health (Honolulu, HI)
- …pharmacist the incumbent may also review UM requests; provide consultation into the case and disease management identification process, and consult with the ... and member educational initiatives that promote the Organization's Formularies, utilization management programs, and case / disease management initiatives;… more
- Intermountain Health (Honolulu, HI)
- …+ Demonstrated ability to exercise critical thinking skills. **Preferred Qualifications** + Case Management Certification. + Experience working in clinical care ... ED Social Worker you will remotely provide substance use assessments/placements, mental health resources, death and dying support, care management services,… more
- Highmark Health (Honolulu, HI)
- …location. Work with Pharmacy Markets business owners, stakeholders and other management , as required, to achieve Pharmacy Markets growth objectives. Organize and ... to understand business needs, processes project specifications and business case development. Translate business needs into clearly defined and documented,… more
- Highmark Health (Honolulu, HI)
- …such as verifying benefit coverage for the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review. ... verification of benefit eligibility. Build cases in the utilization management system. + Use knowledge of process and judgement...0 - 1 year of experience working in the Health Insurance Industry **LICENSES AND CERTIFICATIONS** **Required** + None… more
- Elevance Health (Kapolei, HI)
- …evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and community services ... of an RN, with overall responsibility for the member's case , as required by applicable state law and contract,...and in conjunction with the RN, member and the health care team, to ensure cost effective and efficient… more
- Sutter Health (Ewa Beach, HI)
- …treatment plans. Knowledge and understanding of human behavior and communication, psychotherapy, case management , and the influence of cultural and spiritual ... **Organization:** Sutter Health Pacific **Position Overview:** Provides biopsychosocial assessment, individual/group treatment, family therapy, discharge and… more
- Sutter Health (Ewa Beach, HI)
- **Organization:** Sutter Health Pacific **Position Overview:** Evaluate, diagnose, and treat patients with mental, emotional, and behavioral disorders. They ... are merely the most descriptive of the current job. Management reserves the right to revise the job description...assess and adjust treatment plans Coordinate and communicate with case managers and other stakeholders about treatment and care… more
- US Marine Corps (Kaneohe, HI)
- …development, aid in child abuse prevention and promote good overall mental health . Conducts clinical assessments of families and children receiving services and ... Marine Corps New Parent Support Program (NPSP) program. Maintains individual case records IAW with prescribed regulations and ensures confidentiality and security… more
- Humana (Honolulu, HI)
- …focusing on quality management , utilization management , case management , discharge planning and/or home health or post-acute services such as ... + Provide thought leadership and consulting expertise on population health management approaches and metrics specific to...the senior population with a strong lens on intersecting behavioral and social health needs. + Provide… more
- US Marine Corps (Kaneohe, HI)
- …possess a master's degree in social work or psychology; or in a related behavioral health field (marriage and family therapy, counseling) from an accredited ... conducts seminars and training programs for facility, installation, and community health -care providers and staff, leaders, and peer professional as assigned. Keeps… more
- Marriott (Honolulu, HI)
- …States **Schedule** Full-Time **Located Remotely?** Y **Relocation?** N **Position Type** Management **JOB SUMMARY** Come join a dynamic team on the world-class ... and Experience** **Required:** * 8+ years' experience in release and/or engineering management * Strong understanding of software quality best practices * Strong… more
- US Courts (Honolulu, HI)
- …to standard federal benefits such as paid vacation and sick time, health /dental/vision insurance, life insurance, long term care, flexible benefits ( health ... During the presentence phase, officers apply US Sentencing Commission guidelines and case law; decide the appropriate course of action after analyzing any objections… more
- Merck (Honolulu, HI)
- …conjunction with the research laboratory Therapy Areas, and when appropriate, Human Health colleagues. Contribute to the program life-cycle management through ... in a highly matrix-based organization. There are some interfaces with Human Health /Global Medical Affairs (GMA). **Primary activities:** + Provide Leadership to the… more