• Utilization Management Reviewer…

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …Registered Nurse, LICSW, LMHC + 3-5 years of clinical experience in Behavioral Health Care settings + Utilization Management experience preferred + CCM ... highly dedicated and motivated team of professionals, including medical and behavioral health care managers, dieticians, pharmacist, clinicians, medical… more
    Blue Cross Blue Shield of Massachusetts (10/25/24)
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  • Behavioral Health Utilization

    Healthfirst (NY)
    …for Medicare & Medicaid Services (CMS) or New York State Department of Health (NYSDOH) regulations governing medical management in managed care + Relevant ... **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes:...with non-partner providers, where applicable. Ensures appropriate access and utilization of a full continuum of network and community… more
    Healthfirst (11/24/24)
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  • Utilization Management

    Humana (Columbus, OH)
    …help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
    Humana (11/13/24)
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  • Manager II Behavioral Health

    Elevance Health (Hermitage, PA)
    …The **Manager II Behavioral Health Services** will be responsible for Behavioral Health Utilization Management (BH UM), or Behavioral ... **Manager II Behavioral Health Services** **Location:** This position...and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience, which includes a minimum… more
    Elevance Health (11/15/24)
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  • Coord- Behavioral Health Ult Mg

    BronxCare Health System (Bronx, NY)
    Overview The Coordinator- Behavioral Health Utilization Management (BH-UMC) will review and monitor all patientsadmitted into psychiatry or substance ... for appropriateness of admission according to nationally recognizedcriteria. Responsibilities The Coordinator- Behavioral Health Utilization Management more
    BronxCare Health System (09/18/24)
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  • Manager II Behavioral Health

    Elevance Health (Cerritos, CA)
    The **Manager II Behavioral Health Services** is responsible for Behavioral Health Utilization Management (BH UM), or Behavioral Health ... + MS in social work, counseling, psychology or related behavioral health field or a degree in...and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience, which includes a minimum… more
    Elevance Health (10/09/24)
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  • Behavioral Health Medical Director

    Kepro (Indianapolis, IN)
    … Medical Director shall provide the clinical and administrative medical oversight for Behavioral Health Utilization Management reviews. The Medical ... the public sector. Acentra is looking for a Part-Time Behavioral Health Medical Director to join our...clinical specialty if MD or DO. + Experience in Utilization Management (UM) with knowledge of Medicaid… more
    Kepro (11/26/24)
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  • Utilization Reviewer Coordinator

    Wellpath (Fort Lauderdale, FL)
    …care related field. + Bachelor's degree preferred. + Knowledge of behavioral health systems and Utilization Management required. Experience + Minimum two ... prevent unnecessary re-hospitalization. + Provide counsel and in-service training on utilization management practices as applicable. + Identify alternative… more
    Wellpath (11/22/24)
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  • Behavioral Health Clinical Quality…

    Elevance Health (Hermitage, 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 ... studies including, but not limited to the development and implementation of behavioral health outcomes improvement interventions such as newsletter article,… more
    Elevance Health (10/04/24)
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  • Utilization Management Clinician…

    CVS Health (Salt Lake City, UT)
    …coordinate, document and communicate all aspects of the utilization /benefit management program for preauthorization for mental health services. Applies ... clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus… more
    CVS Health (11/21/24)
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  • Utilization Management Specialist

    FLACRA (Clifton Springs, NY)
    …experience in the behavioral health field, with knowledge of utilization management practices. + Valid NYS Driver's License. Job Requirements: Key ... Utilization Management Specialist Finger Lakes Addiction...Recovery Agency (FLACRA) is a growing, not-for-profit provider of behavioral health and substance use treatment services… more
    FLACRA (11/20/24)
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  • Clinical Reviewer - Behavioral

    Kepro (AR)
    … setting, conducting behavioral health utilization reviews or behavioral health case management . + Ability to work with HIPAA confidential ... the Clinical Director and Team Supervisor, monitors provider trends, reviews government-funded behavioral health program utilization activities, and makes… more
    Kepro (11/21/24)
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  • ABA Utilization Review (UR) Specialist

    Spectrum Billing Solutions (Skokie, IL)
    …+ Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist | UR Specialist ... Review Specialist | ABA Utilization Review Specialist | ABA Utilization Management Specialist | ABA UR Specialist | Behavioral Health Billing… more
    Spectrum Billing Solutions (11/16/24)
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  • Utilization Management Clinical…

    CVS Health (Phoenix, AZ)
    …make health care more personal, convenient and affordable. **Position Summary** Utilization management is a 24/7 operation. Work schedules will include ... weekend, holidays, and evening rotations. ABA Utilization Management Clinical Consultant applies critical thinking and is knowledgeable in clinically appropriate… more
    CVS Health (11/21/24)
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  • Utilization Management Clinical…

    CVS Health (Charleston, WV)
    …clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. ... **Required Qualifications** + Must reside in West Virginia + Licensed independent behavioral health clinician with West Virginia state licensure (LCSW, LPCC,… more
    CVS Health (11/07/24)
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  • Consultant, Behavioral Health I

    Lincoln Financial Group (Columbus, OH)
    …including 1 year in claims, disability management (STD/LTD), worker's compensation, utilization review, and or behavioral health case management ... available for this opportunity. **Requisition #:** 73937 **The Role at a Glance** As a Behavioral Health Consultant, you will be part of a growing mental … more
    Lincoln Financial Group (11/22/24)
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  • Utilization Management Clinician,…

    CVS Health (Austin, TX)
    …standard business hours. No nights, weekends or holidays.** **As a UM Clinician Behavioral Health you will:** + Utilize clinical experience and skills in ... with clients with an Autism Diagnosis + Valid unrestricted independent professional behavioral health clinical license to practice per state regulations in… more
    CVS Health (11/23/24)
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  • Behavioral Analysis Utilization

    CVS Health (Tallahassee, FL)
    …reside in state of Florida, position is 100% remote._** Behavior Analysis Utilization Management Clinical Consultant applies critical thinking and is ... clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health , specific to Behavior Analysis. Utilizes clinical… more
    CVS Health (11/13/24)
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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 ... from accidental, intentional, or inappropriate disclosure. **DEPARTMENT REQUIRED EDUCATION** Department, Behavioral Health : Master's in Social Work or related… more
    Sutter Health (10/24/24)
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  • Utilization Review Clinician…

    Centene Corporation (Raleigh, NC)
    …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
    Centene Corporation (11/22/24)
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