- CVS Health (Tallahassee, FL)
- …**_Must reside in state of Florida, position is 100% remote._** Behavior Analysis Utilization Management Clinical Consultant applies critical thinking ... clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health, specific to Behavior Analysis . Utilizes clinical… more
- AdventHealth (Glendale Heights, IL)
- …Oversees and coordinates compliance to federally mandated and third-party payer utilization management rules and regulations. Qualifications **The expertise and ... role you'll contribute:** Provides health care services regarding admissions, case management , discharge planning and utilization review. **The value you'll… more
- Elevance Health (FL)
- …PulsePoint office. This utilization management role is responsible for utilization management review for Behavior Analysis services. **How you will ... met: performs UM approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and there...is licensed staff supervision. + Previous experience in case management / utilization management with a broad… 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 institution, navigating the complexities of patient care and resource utilization management , and education. Primary responsibilities include: 1.… more
- Beth Israel Lahey Health (Burlington, MA)
- …job, you're making a difference in people's lives.** **Job Description:** The Utilization Analyst works with physicians, the payers and inpatient case management ... medical necessity of the hospital care. Using the concepts of utilization review, clinical documentation improvement and revenue integrity, these specialized case… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts, mandates,… more
- US Tech Solutions (Columbia, SC)
- …established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/ analysis , ... mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/case management /clinical/or combination; 2 of 4 years… more
- Acacia Network (Bronx, NY)
- …degree required (Bachelor's Degree preferred) + Minimum of 2 years of case management and/or utilization review experience + Strong problem-solving and advanced ... Acacia Network Inc. Utilization Manager Bronx, : 5/30/2024 Job Description Job...the community, from children to seniors, a pathway to behavioral and primary healthcare, housing, and empowerment. We are… more
- CVS Health (Tallahassee, FL)
- …will require manipulation and analysis of data to support behavioral health initiatives on the quality management team. **Responsibilities include:** ... records or systems to document root cause of high utilization of care. The QM BH Consultant develops and...collection and review of case and medical records for behavioral health quality activities, including root cause analysis… more
- Elevance Health (Hermitage, PA)
- …locations. The **Manager II Behavioral Health Services** will be responsible for Behavioral Health Utilization Management (BH UM), or Behavioral ... following criteria are met; performs UM approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and there is licensed staff… more
- UPMC (Moosic, PA)
- …consultation with practitioners in the field. This includes significant responsibility for quality management and utilization management and for assuring the ... you will assure the quality and efficiency of the behavioral health care delivered to Community Care members. Incorporated...protocols. + Review the medical aspects of cost and utilization reports generated by Medical Management Information… more
- CVS Health (Tallahassee, FL)
- …Aetna state Medicaid plan. This may include substance use disorder (SUDS), Applied Behavioral Analysis (ABA), Trauma Informed Care, Person Centered Services, and ... the plan and works across various departments including Care Management , Utilization Management , Quality ... Management , Quality Management , and Medical Management on issues related to Behavioral Health.… more
- Immigration and Customs Enforcement (Jena, LA)
- …manage serious mental illness (SMI) caseload. Provides on-site counseling, psychotherapy, behavioral analysis , substance abuse education, and therapy as ... Service Corps (IHSC), Office of the Deputy Assistant Director of Clinical Services, Behavioral Health Unit. This position is supervisory. This position is only open… more
- CVS Health (Tallahassee, FL)
- …internal/external clinician support as required including working with the Care Management and Utilization Management teams. **Position Responsibilities:** ... health care more personal, convenient and affordable. **Position Summary:** The Behavioral Health Liaison directs coordination of care between the Aetna benefits… more
- Magellan Health Services (Albuquerque, NM)
- …the delivery of appropriate health care by overseeing the service coordination, utilization management , care/case management , population health/disease ... cost of care of clinical programs through review and analysis of utilization and financial data., Assists...overseen by the assigned position which includes metrics for utilization and quality management . Develops mitigating strategies… more
- Healthfirst (NY)
- …Health Homes, Claims, Authorizations, Cultural Competency, Evidence Based Practices, Utilization Management , HCBS eligibility/assessment and the secure provider ... + Assists in the development and recruitment of the Behavioral Health network based on department needs and Healthfirst priorities. + Negotiates and executes Single… more
- Elevance Health (NJ)
- …following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and there is licensed staff ... licensed BCBA and will be responsible for reviewing autism utilization cases. The ** Behavioral Health Care Manager...qualifications, skills, and experiences: + Previous experience in case management / utilization management with a broad… more
- Magellan Health Services (Honolulu, HI)
- …appropriate for complex case management and timely completion of all utilization management activities. Involvement in the development of case management ... plans. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care,… more
- Dartmouth Health (Keene, NH)
- …physician practice, while emphasizing care coordination across the continuum. Perform utilization management activities as necessary to ensure that medical ... Functioning as a member or the Behavioral Health Team, the Master's Level Clinician, in...critical pathways and outcome measurement preferred. Experience in case management , utilization review and discharge planning preferred.… more
- Centene Corporation (Tallahassee, FL)
- …abuse across the continuum of care. Experience with managed care, case management , utilization management , or quality improvement. **License/Certification:** ... review of member clinical records and services related to behavioral health and substance use. + Interpret and present...member satisfaction + Serve as resource and liaison on utilization , quality improvement and case management activities… more