- AmeriHealth Caritas (Newtown Square, PA)
- Role Overview The Utilization Management Review Supervisor manages a remote team of clinical reviewers who process prior authorization requests for Community ... Provide daily oversight, support, and direction to a remote team of Utilization Management Reviewers Clinical and technical support: Offer guidance on… more
- UNC Health Care (Hendersonville, NC)
- … behavioral health services. Working closely with behavioral health clinicians, utilization review , case management , and finance teams, the Intake ... information to ensure appropriate care transition and patient placement. Liaise with utilization review , psychiatry leadership, risk management , and/or legal… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. - Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... in behavioral health clinical practice, provider relations, or healthcare management Desired Experience (nice to have): - Experience working with managed care… more
- Highmark Health (Salt Lake City, UT)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... executing all facets of the Informatics project management process, leading multiple project managers, and potentially guiding,...assist in the resolution of issues or problems. Access, review , utilize, contribute content to and participate in the… more
- Washington Metropolitan Area Transit Authority (New Carrollton, MD)
- …as required. + Provides expert advice, guidance, and consultation to WMATA's senior management on space utilization & allocation. + Develops and manages updates ... 8+ years of experience in interior architectural design, administrative office facilities management , and at least 5 years of experience in facilities occupancy… more
- Centene Corporation (Salem, OR)
- …of clinical nursing or case management experience. Managed care or utilization review experience preferred. License/Certification: LPN, LVN, or RN license. ... Texas Requirements: RN license required within Utilization Management at Superior HealthPlan or LPC,...in healthcare or home health settings. Managed care or utilization review experience preferred. Licenses/Certifications: Current state… more
- Battelle Memorial Institute (Columbus, OH)
- …program operations and high-quality patient care. **Responsibilities** + Assist with the management and treatment of outpatient behavioral health activities + ... in a dynamic, mission-driven environment. This position supports outpatient behavioral health activities by conducting intake interviews, assisting with patient… more
- Commonwealth Care Alliance (Boston, MA)
- …Work collaboratively with internal departments-including Clinical Operations, Contracting, Network Management , Utilization Management , and Business ... Knowledge, Skills, Abilities & Language (nice to have):** + Familiarity with care management and utilization management systems and workflows for populations… more
- Battelle Memorial Institute (Sneads Ferry, NC)
- …environment. The Licensed Clinical Social Worker position serves as a behavioral health care provider within operational units, delivering evidence-based assessment, ... maintaining detailed medical records, possibly supervising trainees, performing case management , and engaging in military-specific training and activities as… more
- Highmark Health (Columbia, SC)
- …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... terms through regular on-site audits. Apply an active role in network management , training, monitoring and enforcement of company policies and procedures while… more
- The Cigna Group (Bloomfield, CT)
- …Area of Operation - Colorado, Utah, Pacific Northwest As part of Cigna Pharmacy Management , the Pharmacy Sales Advisor is a licensed clinician who serves as the ... of an integrated benefit, which typically includes Medical, Pharmacy, and Behavioral . This includes service support, reporting, pricing, and/or other performance… more
- Highmark Health (St. Paul, MN)
- …internal clinical and value-based evaluation committees that drive formulary and utilization management functions. Participate in product specific Pharmacy and ... value of implemented initiatives. Lead product based pharmacy trend management discussions with internal partners including senior executives. Support...Therapeutics Committees and Drug Utilization Review (DUR) Committees as necessary or… more
- Carnegie Mellon University (Pittsburgh, PA)
- …Provide analytical support and financial insight for audits, facilities projects, space utilization , grants management , and special projects. Coordinate with the ... spirit, and collaboration From creative writing to statistics and data science, behavioral economics to social and political history, Dietrich College is home to… more
- Monte Nido (Waltham, MA)
- …regulatory agencies. + Conduct psychosocial assessments, participate in treatment planning, utilization review , and discharge planning. + Conduct individual, ... the opportunity for people to realize their healthy selves. **Family Therapist** **Walden Behavioral Care** **Waltham, MA** Walden Behavioral Care is one of the… more
- Highmark Health (Hartford, CT)
- …and mentorship in areas of expertise and architecture to peers, developers, management , and business users. Key Responsibilities: Lead the design and definition of ... the effective application of appropriate design standards, methods, and tools. Review application designs to ensure optimal technology selection, efficient resource … more
- Carnegie Mellon University (Pittsburgh, PA)
- …Provide analytical support and financial insight for audits, facilities projects, space utilization , grants management , and special projects. + Coordinate with ... spirit, and collaboration From creative writing to statistics and data science, behavioral economics to social and political history, Dietrich College is home to… more
- Battelle Memorial Institute (San Diego, CA)
- …validity and significance of collected data, prepare written notes integrating behavioral observations and test results, make recommendations for further action + ... Medical Evaluation Board (MEB), Temporary Disability Retirement List (TDRL) status review , Physical Evaluation Board (PEB), and clinical consultations from various… more
- Monte Nido (White Plains, NY)
- …may substitute leadership experience elsewhere. + Working knowledge of admissions and intake, Utilization Review , and 3rd party or insurance payers. + Previous ... Experience in an Eating Disorder program or other residential behavioral health setting is very helpful. + Knowledge of...Equity and Inclusion practices + Employee selection and performance management experience are a plus. + Must hold a… more
- Humana (Annapolis, MD)
- …care to seniors, including wellness visits, physical exams, chronic condition management , screenings, minor injury treatment and more. CenterWell Senior Primary ... most. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being. About CenterWell,… more
- Monte Nido (Clifton, VA)
- …may substitute leadership experience elsewhere. + Working knowledge of admissions and intake, Utilization Review , and 3rd party or insurance payers. + Previous ... Experience in an Eating Disorder program or other residential behavioral health setting is very helpful. + Knowledge of...Equity and Inclusion practices + Employee selection and performance management experience are a plus. + Must hold a… more
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