- 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
- Humana (Richmond, VA)
- …such as provider relations, claims submission and payment, utilization management processes, behavioral health processes, and dispute resolution. ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Senior...educational material, or trainings. + 3+ years of project management experience with mid-size projects. + 2+ years of… 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
- 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
- Elevance Health (Richmond, VA)
- …initiatives. **Minimum Requirements:** + Requires MA/MS in social work counseling or a related behavioral health field or a degree in nursing, and minimum of 3 ... in Virginia and within 50 miles of an Elevance Health PulsePoint office. Responsible for managing psychiatric and substance...is licensed staff supervision. + Previous experience in case management / utilization management with a broad… more
- HCA Healthcare (Richmond, VA)
- …Do you want to join an organization that invests in you as a(an) Behavioral Health Pract PRN? At Chippenham Hospital, you come first. HCA Healthcare ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free...next level of care. + Has working knowledge of utilization management functions and performs these duties… 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
- Highmark Health (Richmond, VA)
- …:** **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 (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 (New Kent, VA)
- …identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term ... chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. + Obtains a thorough and accurate… 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
- Humana (Richmond, VA)
- …and subpopulations. Areas of focus include Care Management , Quality Improvement, Utilization Management , Population Health , Social Determinants of ... Health , Pharmacy, Behavioral Health , and Long-Term Services and Supports. Key responsibilities include: + Lead the development of actionable go-to-market… 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
- 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)
- …**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 (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