• Utilization Management Clinician…

    CVS Health (Raleigh, NC)
    …schedules will include weekends, holidays, and evening hours._ As a Utilization Management Clinician - Behavioral Health you will utilizes clinical ... and keyboarding + Must have active current and unrestricted Behavioral Health clinical licensure (LPC, LMSW, LSW,...Friday with flexible hours between 10:00am to 8:00pm EST. Utilization Management is a 24/7 operation and… more
    CVS Health (07/02/25)
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  • Utilization Management Clinician…

    CVS Health (Richmond, VA)
    …No weekends or holidays. + 1+ years of utilization review/ utilization management required. + 3+ years of behavioral health clinical experience in ... clinically appropriate treatment, evidence based care an clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. +… more
    CVS Health (06/25/25)
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  • Supervisor, Behavioral Health

    Centene Corporation (Tallahassee, FL)
    …appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization ... CANDIDATE WILL HAVE BCBA CERTIFICATION **Position Purpose:** Supervises the behavioral health (BH) utilization review...performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH… more
    Centene Corporation (06/26/25)
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  • Utilization Management Clinician…

    CVS Health (Harrisburg, PA)
    …every day. **Position Summary** This is a full-time, remote position. The Medicare Behavioral Health Outpatient clinician will be part of the Medicare ... to promote quality effectiveness of healthcare services and benefit utilization . The Utilization Management Clinician...and no weekends. **Required Qualifications** + 3+ years of behavioral health clinical experience + Must have… more
    CVS Health (06/23/25)
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  • Utilization Management Nurse…

    CVS Health (Phoenix, AZ)
    …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Key ... Apply critical thinking and evidence-based clinical criteria specific to Behavioral Health and Substance Abuse to evaluate...a computer. + Flexibility to provide coverage for other Utilization Management (UM) nurses across various UM… more
    CVS Health (06/21/25)
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  • Manager, UM Behavioral Health

    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
    Humana (06/26/25)
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  • Case Manager, RN or Licensed Behavioral

    Excellus BlueCross BlueShield (Rochester, NY)
    …of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health , Pharmacy, Registered ... Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health , Respiratory Therapy, Registered Dietitian, Registered Nurse,… more
    Excellus BlueCross BlueShield (06/27/25)
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  • Health Equity & Community Investments…

    Excellus BlueCross BlueShield (Rochester, NY)
    Management functional areas, such as, but not limited to Case Management , Utilization Management , Behavioral Health , Medical Claim Review and ... as needed. + Provides reports and recommendations to the Utilization Management /Case Management (UM/CM) team... health plan in a role related to utilization management /case management interventions/programs or… more
    Excellus BlueCross BlueShield (07/02/25)
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  • Behavioral Health Care Manager

    AmeriHealth Caritas (Harrisburg, PA)
    …experience in Adult Behavioral Health Service Delivery System;required + Behavioral Health Utilization Management experience and/or experience in ... helps health plans and customers provide comprehensive behavioral health management strategies and...medical Providers when applicable. The BH-CCM approves care coordination, utilization management , and some types of case… more
    AmeriHealth Caritas (07/01/25)
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  • Case management Director- Central Region

    Ascension Health (Indianapolis, IN)
    …of: + Discharge planning + Medicare/Medicaid regulations + Utilization review and management + Behavioral health and social determinants of health ... **Details** + **Department: Case Management - Central Region** + **Hospital: Ascension St. Vincent**...transfer date. + Social Worker credentialed from the Indiana Behavioral Health and Human Services Licensing Board… more
    Ascension Health (05/30/25)
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  • Medical Director, Behavioral Health

    Centene Corporation (Olympia, WA)
    …and support of the Chief Medical Officer to direct and coordinate the behavioral health medical management , quality improvement and credentialing functions ... as mental health parity, community services overutilization, prior authorization, and utilization management reform. + Serve as the internal subject matter… more
    Centene Corporation (05/04/25)
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  • Vice President, Behavioral Health

    Centene Corporation (Olympia, WA)
    …as mental health parity, community services overutilization, prior authorization, and utilization management reform. + Serve as the internal subject matter ... as mental health parity, community services overutilization, prior authorization, and utilization management reform. + Analyze data related to behavioral more
    Centene Corporation (05/20/25)
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  • Behavioral Health Utilization

    Baylor Scott & White Health (Dallas, TX)
    …experience and/or behavioral health treatment + Experience with Utilization Management for Substance use treatment experience and/or behavioral ... and improving care quality. **Essential Functions of the Role** + Process all Behavioral Health and Substance Use Disorder authorizations within the designated… more
    Baylor Scott & White Health (06/07/25)
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  • Utilization Review Specialist,…

    Sutter Health (Berkeley, CA)
    …systems for the appeal/denial process, tracks and trends data, and coordinates utilization management activities for the assigned area. Collaborates with ... staff changes, workload, or technical development)._ **DEPARTMENT REQUIRED EDUCATION** Department, Behavioral Health : Master's in Social Work or related field… more
    Sutter Health (06/13/25)
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  • Utilization Review Intake RN…

    AdventHealth (Glendale Heights, IL)
    …AVE, Glendale Heights, IL 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by ... including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a...+ Associate's of Nursing Required + RN experience in behavioral health preferred + Must be able… more
    AdventHealth (06/13/25)
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  • Utilization Review Clinician…

    Centene Corporation (Tallahassee, FL)
    …in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of ... licensed and located in FL. Ideal candidate will have experience in Utilization Management .** **Education/Experience:** Requires Graduate of an Accredited School… more
    Centene Corporation (06/20/25)
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  • Behavioral Health Utilization

    Actalent (Sunrise, FL)
    Utilization Management Nurse!Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ... activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management ...employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee… more
    Actalent (06/29/25)
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  • Utilization Management Clinical…

    CVS Health (Columbus, OH)
    …schedules **Preferred Qualifications** + Utilization review experience strongly preferred + Behavioral health experience + Experience in a behavioral ... **Position Summary** This Clinical Consultant position is with Aetna's Utilization Management (UM) team and is a...requirements is for candidates to hold a Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or… more
    CVS Health (07/02/25)
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  • Utilization Management Clinical…

    CVS Health (Columbus, OH)
    utilization /benefit management function **Required Qualifications** + Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered ... to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking...utilization review experience preferred + Experience in a behavioral health inpatient setting + Ability to… more
    CVS Health (07/03/25)
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  • Utilization Management Clinical…

    CVS Health (Charleston, WV)
    utilization /benefit management function. Required Qualifications: + Licensed independent Behavioral Health clinician or a Registered Nurse (RN) with ... do it all with heart, each and every day. ** Utilization Management Clinical Consultant** **Remote - West...utilization review experience preferred + Experience in a behavioral health inpatient setting + Ability to… more
    CVS Health (07/03/25)
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