- Humana (Springfield, IL)
- …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
- 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 Billing… more
- Evolent (Springfield, IL)
- …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
- Prime Healthcare (Aurora, IL)
- …Peds and Intensive Care, Mercy is a destination for specialty care - including behavioral health , heart, cancer, stroke care, orthopedics and women's health . ... and illnesses. Our care teams listen to understand your health needs and deliver care that's right for you....review and appeals process as part of the denial management initiatives. + Utilization review tech is… more
- Prime Healthcare (Chicago, IL)
- …provides a full range of services, including primary care, cancer care, behavioral health , orthopedics and rehab, cardiology, imaging, midwifery and obstetrics, ... Our patient-centered, multilingual care teams listen to understand your health needs and deliver care that's right for you....review and appeals process as part of the denial management initiatives. + Utilization review tech is… more
- CVS Health (Springfield, IL)
- …meetings in Chicago/Downer's Grove area.** **Position Summary** The Clinical Case Manager, Behavioral Health , is responsible for driving and supporting care ... care management activities with members to ensure that their medical and behavioral health needs are met and to enhance the member's overall wellness.… more
- Highmark Health (Springfield, IL)
- …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 (Springfield, IL)
- …*Minimum 2 years of direct clinical practice experience post masters in Behavioral Health *Minimum 1+ year of Case Management experience *Willing and able to ... and/or trainings in Downers Grove IL as needed/requested by Management .** Preference for candidates residing in the Chicago area....activities with members to evaluate the medical needs and behavioral health needs of the member to… more
- CVS Health (Springfield, IL)
- …* Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate ... care issues through established channels * Ability to speak to medical and behavioral health professionals to influence appropriate member care. * Utilizes… more
- CVS Health (Springfield, IL)
- …cost for our clients: quantifying how our various products and programs (eg, utilization management ) are impacting pharmacy cost trends, and helping prioritize ... Bring your heart to CVS Health . Every one of us at CVS ...to provide timely, accurate, actionable data and analysis for utilization and unit cost management to reduce… more
- Trinity Health (Berwyn, IL)
- …medication petitions. OUTPATIENT: Conducts group therapy sessions and performs case management responsibilities for behavioral health patients participating ... opportunity for a LCPC/LCSW in the Outpatient Counseling Clinic - Berwyn, Illinois. The Behavioral Health team is seeking future colleagues with a passion to… more
- CVS Health (Springfield, IL)
- …- Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate ... care issues through established channels - Ability to speak to medical and behavioral health professionals to influence appropriate member care. - Utilizes… more
- Elevance Health (Chicago, IL)
- …as related to oncology drivers. Responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most ... Director** will be supporting our clients in operations with utilization and case management reviews. In addition,...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
- Highmark Health (Springfield, IL)
- …:** **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 (Chicago, IL)
- …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 (Springfield, IL)
- …:** **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
- Little City Foundation (Chicago, IL)
- Clinical Mental Health Supervisor Job Details Job Location Chicago - Chicago, IL Position Type Full Time Education Level MSW | Master's DCFS approved field Job Shift ... and Some Evening / Weeken Description PURPOSE:The Clinical Mental Health Supervisor will lead the implementation of mental ...The omission of an essential function does not preclude management from assigning duties not listed herein is such… more
- Highmark Health (Springfield, IL)
- …, 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 (Springfield, IL)
- …**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 (Springfield, IL)
- …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