- Humana (Jefferson City, MO)
- …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
- Centene Corporation (Jefferson City, MO)
- …in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of ... licensure as outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and ability to review… more
- Evolent Health (Jefferson City, MO)
- …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
- Highmark Health (Jefferson City, MO)
- …:** **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
- Highmark Health (Jefferson City, MO)
- …:** **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
- Humana (Jefferson City, MO)
- …and subpopulations.** Areas of focus include Care Management , Quality Improvement, Utilization Management , Population Health , Social Determinants of ... Health , Pharmacy, Behavioral Health , Long-Term Services and Supports, Health Information...Qualifications** + MBA programs with a specialization in Healthcare Management **OR** Master's Degree in Public Health … more
- Highmark Health (Jefferson City, MO)
- **Company :** Highmark Health **Job Description :** Job Description **JOB SUMMARY** This role within the marketing & experience department will be at the forefront ... includes leveraging cutting-edge customer experience platforms, implementing robust data management solutions, and optimizing marketing automation tools to drive… more
- Highmark Health (Jefferson City, MO)
- …**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 (Jefferson City, MO)
- …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 (Jefferson City, MO)
- …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
- Humana (Jefferson City, MO)
- …of clinical conditions and disease states, such as hypertension, diabetes, kidney care, behavioral health and/or other chronic conditions + Deep understanding of ... part of our caring community and help us put health first** Humana's Clinical Analytics Team is seeking a...other specific healthcare areas such as EMR, Episode grouper, utilization management , value-based care, low value care… more