- 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… more
- CVS Health (Columbus, OH)
- …applicants whose only acute care experience is in behavioral health ) **Preferred Qualifications** + 1+ years' experience Utilization Review experience ... Bring your heart to CVS Health . Every one of us at CVS ...care more personal, convenient and affordable. **Position Summary:** This Utilization Management (UM) Nurse Consultant role is… more
- Evolent (Columbus, OH)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Evolent (Columbus, OH)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Intake … more
- Elevance Health (Columbus, OH)
- …companies, Carelon Behavioral Health , offers superior clinical mental health and substance use disorder management , a comprehensive employee assistance ... and insightful analytics to improve the delivery of care._ ** Behavioral Health Care Manager II - Applied...is licensed staff supervision. + Previous experience in case management / utilization management with a broad… more
- Highmark Health (Columbus, OH)
- …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 (Columbus, OH)
- …issues. Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the ... **Required Qualifications** + Must be Ohio Resident. + Active Behavioral Health license in the state Ohio...BH Clinical License: LPCC, IMFT, or LISW + Managed care/ utilization review experience + Case management and… more
- Molina Healthcare (Columbus, OH)
- …Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health ... and chemical dependency services and assists with implementing integrated Behavioral Health care management programs....for utilization management and case management programs for mental health and chemical… more
- Humana (Columbus, OH)
- …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
- CVS Health (Columbus, OH)
- …state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health Plan / Payor ... and New Jersey offering a variety of physical and behavioral health programs and services to its...can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will… more
- Elevance Health (Columbus, OH)
- …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...of Internal, Family, Neonatal, and/or OBGYN strongly preferred. + Utilization management experience is a PLUS. Please… more
- Highmark Health (Columbus, OH)
- …:** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent assesses ... coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Elevance Health (Columbus, OH)
- …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 (Columbus, OH)
- …:** **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
- Conviva (Columbus, OH)
- …of care, quality management , utilization management , case management , discharge planning and/or home health or post-acute services such as inpatient ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience...and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral … more
- Highmark Health (Columbus, OH)
- …, 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 (Columbus, OH)
- …**SKILLS** + Driving technology sales + Background on IT + Background in Care Management , Utilization Management , and Digital Products and Services + ... channel growth for enGen. Work closely with marketing, sales engineering and product management to deliver on targets, objectives and provide a voice of the partner.… more
- Highmark Health (Columbus, OH)
- …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
- Highmark Health (Columbus, OH)
- …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
- Highmark Health (Columbus, OH)
- …in business terms and values. + Manage expectations of customers and management . + Represent various architectural disciplines in customer reviews and planning, ... in their areas of expertise and architecture to peers, developers, management and business users including technical expertise, coaching and ad-hoc training.… more