- 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
- Evolent (Richmond, VA)
- …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 (Richmond, VA)
- …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 (Richmond, VA)
- …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 (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)
- …positive outcomes and enhance overall well-being. **What you will do** + Coordinates behavioral health assessments to gain information on substance abuse history ... measurable outcomes. + Configures electronic medical software to categorize behavioral health conditions by severity. + Edits...to deliver an impactful message surrounding client rights and health needs. + Examines the data management … 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
- Humana (Richmond, VA)
- …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
- 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)
- …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
- 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
- Conviva (Richmond, VA)
- …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 (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
- Stantec (Charlottesville, VA)
- …settings and academic medical centers with specialty areas of focus including behavioral health , oncology inclusive of particle therapy and cardiovascular care. ... Principal, US Federal Health Leader - ( 240003L1 ) **Description** Stantec... Sector Leader for strategic planning, project execution, financial management , talent retention and recruitment to successfully deliver projects… 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 (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
- 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