- 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
- 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
- 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
- Spokane County (Spokane, WA)
- …for substance use disorder assessment and treatment. + Knowledge of utilization management of public behavioral health . + Knowledge of federal ... behavioral healthcare services, healthcare coordination or authorization and utilization reviews of behavioral health ...Coordinator: + Performs utilization management , utilization review, or concurrent review of behavioral … more
- 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
- 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
- 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
- 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 (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
- VNS Health (Manhattan, NY)
- …effective quality care is being provided as needed.* Reviews utilization , care management and behavioral health (BH) data; identifies trends and needs ... guidance to the daily operations and administration of medical management for VNS Health Plans. Assists senior...cases. Participates in the QARR/HEDIS Quality Improvement Activities and utilization management of the population. Works under… more
- VNS Health (Manhattan, NY)
- …implementation of the behavioral health sections of the Quality Management (QM)/ Utilization Management (UM) Plan. Oversees the administration of all ... Develops, implements, monitors and evaluates Utilization and Care Management metrics specific to Behavioral health services across all plan types as… more
- 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
- 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
- CareFirst (Washington, DC)
- …for issues related to Medicare/Medicare Advantage, prescription drugs, utilization management , and behavioral health . **ESSENTIAL FUNCTIONS:** The ... by AHIP, the Blue Cross and Blue Shield Association (BCBSA), the Association for Behavioral Health and Wellness (ABHW), and others as needed. + In support… more
- 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
- Centene Corporation (Omaha, NE)
- …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
- AdventHealth (Glendale Heights, IL)
- …you'll contribute:** Provides health care services regarding admissions, case management , discharge planning and utilization review. **The value you'll bring ... Oversees and coordinates compliance to federally mandated and third-party payer utilization management rules and regulations. Qualifications **The expertise and… more
- Munson Healthcare (Traverse City, MI)
- …ED/Hospital initiatives to include: ED throughput, clinical variation, ED utilization management , ED behavioral health , OBS care, appropriateness of ... and education in administrative/leadership skills. + An advanced degree in health administration is desirable, although not mandatory. + Demonstrated experience and… more
- CVS Health (Tallahassee, FL)
- …in Spanish / English **Preferred** **Qualifications** + Outpatient behavioral health experience highly preferred + Managed care/ utilization review experience ... convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Clinical Consultant opportunity for candidates residing in… more
- Stanford Health Care (Palo Alto, CA)
- …**This is a remote Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN) will be responsible for ensuring the ... for preventive care, telemedicine through Teledoc, prescription drug coverage, and behavioral health coverage. Additional incentives exist for healthy choices.… more