- Centene Corporation (Carson City, NV)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
- CVS Health (Harrisburg, PA)
- …. No weekends or holidays. + 1+ years of utilization review / utilization management required. + 3+ years of behavioral health clinical experience in a ... day. **Position Summary-** + **Master's Degree and Independently licensed Behavioral Health Clinician Or Associate Degree and...years BH clinical Experience** + **1 or more years Utilization Management Experience** + **Work at Home role. Can… more
- Novant Health (NC)
- What We Offer Why This Role Matters As a Utilization Review Clinician , you will play a critical role in ensuring the integrity and compliance of patient ... as needed, most holidays required. + Serve as a leader resource in the Utilization Review process for Behavioral Health acute care . + Coordinate and conduct… more
- Centene Corporation (Harrisburg, PA)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... state (BCBA) required. Master's degree for behavioral health clinicians required. Behavioral health clinical knowledge and ability to review and/or… more
- Centene Corporation (Phoenix, AZ)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... have obtained the state required licensure as outlined by the applicable state (BCBA) required. Behavioral health clinical knowledge and ability to review and/or… more
- City and County of San Francisco (San Francisco, CA)
- …such as chart audit and compliance review . + The 2932 Senior Behavioral Health Clinician performs related duties as required. Nature of work requires ... 2. Then, submit an online application. Under direction, the 2932 Senior Behavioral Health Clinician performs essential duties that include, but are… more
- Dartmouth Health (Keene, NH)
- …critical pathways and outcome measurement preferred. Experience in case management, utilization review and discharge planning preferred. Knowledge of JCAHO/NCQA ... Functioning as a member or the Behavioral Health Team, the Master's Level Clinician...is sensitive to patient needs and expectations, promote effective utilization of resources, and support physician practice, while emphasizing… more
- Atlantic Health System (NJ)
- …chart documentation. 8. Incorporates use of criteria sets in context of utilization management. 9. Performs other related duties as assigned. Required:1. Master's ... - Becker's Healthcare + 100 Accountable Care Organizations to Know - Becker's Hospital Review + Best Employers for Workers over 50 - AARP + Gold-Level "Well… more
- Molina Healthcare (Louisville, KY)
- …RN who must be licensed in KY or have a compact RN license. The Care Review Clinician Inpatient Review BH will provide prior authorization for outpatient and ... DESCRIPTION Job Summary Provides support for member clinical service review processes specific to behavioral health. Responsible...teams to promote Molina care model. * Adheres to utilization management (UM) policies and procedures. * May work… more
- City of Durham (Durham, NC)
- …service delivery documentation (including counseling/treatment planning), HIPAA/Confidentiality standards, utilization review , and data management. + Ability ... health, substance use, and conflict mediation needs. The Crisis Response Clinician is responsible for behavioral health assessments, therapeutic interventions,… more
- Hartford HealthCare (Danielson, CT)
- …which may include staff scheduling, scheduling clinical activities, program development, utilization review , case load assignment, and attending meetings as ... and then to the student's home. *_Job Summary_* Lead Behavioral Health Clinician works in coordination with interdisciplinary teams to organize, prepare,… more
- FLACRA (Penn Yan, NY)
- …within the timelines outlined by FLACRA. + Participates in quality initiatives and utilization review activities as requested. + Strives to understand and meet ... Integrated Outpatient Senior Clinician FLACRA Penn Yan, NY (Onsite) Full-Time $34.00/Hour...staff and community service providers. + Knowledge of local behavioral health service system. + Ability to multi-task, have… more
- HCA Healthcare (Dallas, TX)
- …interdisciplinary team members, payer representatives, and other parties as appropriate regarding behavioral services** + **Performs utilization review as ... hours volunteering in our communities. As a(an) Licensed Intake Clinician - PRN with Medical City Green Oaks Hospital...for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services… more
- Molina Healthcare (Sparks, NV)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- Highmark Health (Little Rock, AR)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Molina Healthcare (Akron, OH)
- **JOB DESCRIPTION** Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- CVS Health (Frankfort, KY)
- …with heart, each and every day. **Position Summary** This is a fully **remote** Utilization Review Clinical Consultant. **Must reside in the state of Kentucky or ... the standard schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Foster Care population experience +… more
- Point32Health (MA)
- …the Utilization Management Supervisor, the Behavioral Health (BH) Utilization Management (UM) Clinician is responsible for conducting benefit coverage ... management and care management principles. Health Plan experience performing utilization review activities. Experience with McKesson's InterQual Clinical… more
- Prime Healthcare (Boonton Township, NJ)
- …meetings as required to ensure continuity of care. Completes all required utilization review tasks as assigned. For Outpatient and Residential services/programs ... of hospitals and healthcare facilities include Denville Hospital, Dover Hospital, Behavioral Health Centers in Boonton, Denville, and Parsippany, and an Imaging… more
- Prime Healthcare (Boonton Township, NJ)
- …meetings as required to ensure continuity of care. Completes all required utilization review tasks as assigned. For Outpatient and Residential services/programs ... of hospitals and healthcare facilities include Denville Hospital, Dover Hospital, Behavioral Health Centers in Boonton, Denville, and Parsippany, and an Imaging… more
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