- Elevance Health (Washington, DC)
- …The Mgr II HCMS is responsible for managing a team of physical and/or behavioral health practitioners in the development, implementation, and coordination of a ... comprehensive integrated Medical Management program designed to manage health outcomes...of medical complexity and acuity. Participates in case and/or utilization management execution/decision making for managed member… more
- Elevance Health (Washington, DC)
- …responsible for appeals reviews within our Medicaid and Medicare programs.** The ** Behavioral Health Medical Director** is responsible for the administration of ... behavioral health medical services, to ensure the...clinical reviews. + The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and… more
- Fairfax County Sheriff's Office (Fairfax, VA)
- …(UR) Specialist has well-developed knowledge and skills in areas of utilization management (UM), behavioral health , medical necessity and overall patient ... autonomously as a licensed registered nurse performing an array of utilization management duties related to all Community Mental Health Rehabilitative… more
- CareFirst (Washington, DC)
- …for issues related to Medicare/Medicare Advantage, prescription drugs, utilization management , and behavioral health . **ESSENTIAL FUNCTIONS:** The ... by AHIP, the Blue Cross and Blue Shield Association (BCBSA), the Association for Behavioral Health and Wellness (ABHW), and others as needed. + In support… more
- CenterWell (Washington, DC)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as… more
- Highmark Health (Washington, DC)
- …account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and case/ disease management ... information to improve individual outcomes as an adjunct to health coaching. If acting in the capacity as a...review. + Assist in the development and implementation of utilization management programs including but not limited… more
- Highmark Health (Washington, DC)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Washington, DC)
- …Description :** **JOB SUMMARY** 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
- Highmark Health (Washington, DC)
- …for the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review. Ensures all accurate information is ... including verification of benefit eligibility. Build cases in the utilization management system. + Use knowledge of...0 - 1 year of experience working in the Health Insurance Industry **LICENSES AND CERTIFICATIONS** **Required** + None… more
- Highmark Health (Washington, DC)
- …:** **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
- Elevance Health (Ashburn, 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
- Highmark Health (Washington, DC)
- **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 (Washington, DC)
- …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 (Washington, DC)
- …actions (promotions, hiring, terminations, etc.) Develops talent, Addresses resource management , cultivates capabilities of staff, planning and coordination of work, ... in first-line resolution of complex technical problems 2. Provides Staff Management oversight * Hires, promotes, separates or makes recommendations regarding same… more
- Highmark Health (Washington, DC)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job is a strong advocate of cloud technology and engineering support necessary to drive the ... to senior or lead engineers to further cloud service utilization and optimization. + Develops automation scripts and other...of action. + Level 2 Incident, problem and change management as it pertains to the responsibilities of the… more
- Somatus (Mclean, VA)
- …for our patients and partners. Showing Up for You We offer more than 25 Health , Growth, and Wealth Work Perks to help teammates learn, grow, and be the best ... asynchronous as well as longitudinal basis. + Practice within a population health model which prioritizes robust and reliable provision of timely, proactive… more
- US Army Medical Command (Arlington, VA)
- …clinical setting on a highly specialized multidisciplinary treatment team dealing with mental health issues and supporting Behavioral Health Providers with ... and with any other appropriate multidisciplinary team members to ensure appropriate utilization of mental health care resources. Develop support caseload as… more
- Centene Corporation (Arlington, VA)
- …Required 2+ years of experience in utilization management and/or case management in a hospital or home health setting or with a managed care ... for our 28 million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified, national organization offering… more
- Sharecare, Inc. (Washington, DC)
- …of the health care team to support appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. ... team. Facilitates communication exchange with primary managing physician and other providers, health plan, and the disease management program team. + Coordinates… more
- Prime Therapeutics (Washington, DC)
- …unit, strategic planning and large scale business transformation and/or re-engineering project management in Behavioral Health public sector market is ... systems, and reporting integration. + Utilizes appropriate product and project management methodologies and tools. + Translates highly complex concepts in ways… more