- Humana (Richmond, VA)
- …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- Humana (Richmond, VA)
- …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
- CVS Health (Richmond, VA)
- …of care, and appropriate discharge planning + Serve as the behavioral health subject matter expert to support care management staff in serving Aetna ... foster collaboration and provide education and training + Consults with Plan executive management regarding physical and behavioral health clinical issues as… more
- Elevance Health (Richmond, VA)
- …anywhere in the state of Virginia and must live within 50 miles of an Elevance Health PulsePoint office. This utilization management role is responsible for ... Requires MA/MS in social work counseling or a related behavioral health field or a degree in...is licensed staff supervision. + Previous experience in case management / utilization management with a broad… more
- Highmark Health (Richmond, VA)
- …Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care services, ... utilization , identification of opportunities for referral to a Health Coach/case management , and identification and resolution...years of post licensure experience in a combination of Behavioral Health Clinical, Case Management … more
- CVS Health (Richmond, VA)
- …outreaches and computer documentation. + Assist members with locating community based behavioral health resources. **Required Qualifications** + 3+ years of ... direct clinical practice experience + An active and unrestricted clinical behavioral health license in state of residence is required (ex: LPC, LCSW, LMFT, LPCC,… more
- Humana (Richmond, VA)
- …community and help us put health first** The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and evaluates members' ... care and wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work assignments are varied... of Pedatric member's (Under 21) who utilize Applied Behavioral Analysis (ABA Services). Monitor/have awareness of utilization… more
- Highmark Health (Richmond, VA)
- …in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care services, ... utilization , identification of opportunities for referral to a Health Coach/case management , and identification and resolution...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Elevance Health (Richmond, VA)
- …The **Medical Director** will be responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most ... For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years...+ Background in Internal Medicine is strongly preferred. + Utilization management experience is a PLUS. Please… more
- Elevance Health (Richmond, VA)
- …for over 150 years. With capabilities spanning pharmacy, behavioral health , complex care delivery, medical benefits management , payment integrity, palliative ... risk solution spans 100% of the total cost of care for our patients, integrating utilization management , care management , pharmacy management , and data… more
- Elevance Health (Richmond, VA)
- …A proud member of the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health Options, offers superior clinical mental ... preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For… more
- Highmark Health (Richmond, VA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- HCA Healthcare (Richmond, VA)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... Hospital, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The...+ You will consult with facility-level staff regarding delegated utilization management and disease management … more
- Highmark Health (Richmond, VA)
- …, physician practice management or clinical operations, ancillary provider management or clinical operations, and/or health insurance) with significant ... knowledge of and experience with various care delivery models + Experience in health plan provider network performance management , care/case management ,… more
- Highmark Health (Richmond, VA)
- …(NCQA), Utilization Review Accreditation Committee (URAC), Pennsylvania Department of Health , Department of Labor, the Center for Medicare and Medicaid Services ... review and make determinations regarding physician reviewer assignments for medical management decisions. Cases requiring physician review are provider and member… more
- Highmark Health (Richmond, VA)
- …to deliver financial results to the Enterprise. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the… more
- Bon Secours Mercy Health (Richmond, VA)
- At Bon Secours Mercy Health , we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and ... why we're proud to offer our **Bon Secours Mercy Health Nursing Flex Team** , to help our nurses...and skill based on principles of the biological, physical, behavioral , and social sciences + * Application of the… more
- Bon Secours Mercy Health (Midlothian, VA)
- At Bon Secours Mercy Health , we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and ... and patient-focused organization, Bon Secours exists to enhance the health and well-being of all people in mind, body...and skill based on principles of the biological, physical, behavioral , and social sciences + Application of the nursing… more
- Highmark Health (Richmond, VA)
- …resource efficiency. + Proposes ideas, designs, and solutions to lead engineers and management to further cloud service utilization and optimization. + Develops ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job...of action. + Level 3 Incident, problem and change management as it pertains to the responsibilities of the… more
- Bon Secours Mercy Health (Midlothian, VA)
- At Bon Secours Mercy Health , we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and ... and patient-focused organization, Bon Secours exists to enhance the health and well-being of all people in mind, body...and skill based on principles of the biological, physical, behavioral , and social sciences + Application of the nursing… more