- Altru Health (East Grand Forks, MN)
- …initiating and participating in restructuring of current and new programs. Performs utilization review when required. Collaborates with Primary Care Provider ... Licensed Professional Clinical Counselor (LPCC) | Minnesota Board of Behavioral Health and Therapy | Within 12 Months of...| Within 90 Days of Start Date | Learning Management System Notes: Can by licensed as LCSW or… more
- 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 2 work… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …years of clinical experience in Behavioral Health Care settings + Utilization Management experience preferred + CCM or other applicable certification(s) ... your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care...and BCBSMA policies and procedures + Focus on efficient utilization management with emphasis on discharge planning… more
- Spokane County (Spokane, WA)
- …Care Coordinator: + Performs utilization management , utilization review , or concurrent review of behavioral health inpatient and outpatient ... Integrated Care and the Behavioral Health Administrative Services Organization Utilization Review Integrated Care. TOTAL COMPENSATION: $85,812 - $120,126… more
- CVS Health (Austin, TX)
- …other agency/stakeholder meetings when requested. - Oversight and implementation of the utilization management program for behavioral health services, ... TX's (ABHT) leadership team and is responsible for * Leadership and counsel for utilization management * Leadership and participation in case management … more
- CVS Health (Baton Rouge, LA)
- …other agency/stakeholder meetings when requested. * Oversight and implementation of the utilization management program for behavioral health services, ... over/under- utilization . * Ensuring consistency in the application of utilization management standards, including those implemented by subcontracted entities… more
- Elevance Health (Hermitage, PA)
- …locations. 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 will work...and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience, which includes a minimum… 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 ... the Florida Medicaid Health system strongly preferred + Managed care experience + Utilization review experience + Claims review experience strongly preferred… more
- Kepro (AR)
- …services based on review of clinical records. Preferred Qualifications/Experience: + Utilization Review / Utilization Management experience. + Clinical ... the public sector. Acentra is looking for a Clinical Reviewer - Behavioral Health - PRN (Remote... behavioral health utilization reviews or behavioral health case management . + Ability to… 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… more
- Wellpath (Fort Lauderdale, FL)
- …in a health care related field. + Bachelor's degree preferred. + Knowledge of behavioral health systems and Utilization Management required. Experience + ... health care setting, preferably inpatient preferred. + Minimum one (1) year clinical or utilization review or case management preferred. + Knowledge of… more
- Kepro (Indianapolis, IN)
- …Medical Director shall provide the clinical and administrative medical oversight for Behavioral Health Utilization Management reviews. The Medical Director ... the public sector. Acentra is looking for a Part-Time Behavioral Health Medical Director to join our growing team....Quality Assurance committee responsibility in a hospital setting. + Utilization Management (UM) review experience.… 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 ... according to nationally recognizedcriteria. Responsibilities The Coordinator- Behavioral Health Utilization Management (BH-UMC) will review and monitor… more
- Elevance Health (NC)
- … Behavioral Health OP services. + Mentors Behavioral Health Care Management staff by assisting in training, attending utilization management rounds, ... external Behavioral Health Providers to ensure appropriate and consistent utilization of plan benefits, out of network services, and clinical guidelines within… more
- Magellan Health Services (Honolulu, HI)
- …Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community ... collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or… more
- Chenega Corporation (NM)
- …reporting, analysis, and makes recommendations for improvement. + Refers cases for review as appropriate to Program Integrity, Case Management , Care ... Services** ' company, is looking for a fully remote **Clinical Quality Reviewer ** to ensure compliance with the contract, and program requirements for Clinical… more
- The Cigna Group (Bloomfield, CT)
- Delivers specific delegated tasks assigned by a supervisor in Utilization Management . Handles moderately complex medical review , utilization review , ... appropriate course of action for treatment. May analyze treatment patterns and utilization trends. Contributes to the development and implementation of action plans… more
- Centene Corporation (Olympia, WA)
- …Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Centene Corporation (Madison, WI)
- …with network practitioners to provide education on best practice models and utilization management processes** **Interact with the Medical Director, or designee, ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- VNS Health (Manhattan, NY)
- …and implementation of the behavioral health sections of the Quality Management (QM)/ Utilization Management (UM) Plan. Oversees the administration of ... implements, monitors and evaluates Utilization and Care Management metrics specific to Behavioral health services...community's needs. + Oversees the implementation and monitoring of utilization review and quality management … more
