- AmeriHealth Caritas (LA)
- **Role Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing ... products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more… more
- CenterWell (Baton Rouge, LA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous...and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral … more
- Immigration and Customs Enforcement (Jena, LA)
- …improvement activities/risk identification and management directly related to mental health . Coordinates alongside HQ behavioral health unit for ... Summary The Supervisory Behavioral Health Provider oversees clinical performance,...hunger strike, abuse, neglect and trauma, and integrative case management . Establishes and maintains liaison with other health… more
- Centene Corporation (Baton Rouge, LA)
- …benefits including a fresh perspective on workplace flexibility. **We're Hiring: Full-time Behavioral Health Medical Director** Centene Corporation is a leading ... million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified,...business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality… more
- CVS Health (Baton Rouge, LA)
- … health care innovators. The Engagement Outreach Hub Care Management Associate supports comprehensive coordination of healthcare services through telephonic ... At CVS Health , we're building a world of health...and the working hours are 8am-5pmEST.** **Aetna's Medicaid Care Management Engagement Outreach Hub** is a _new_ initiative focused… more
- CVS Health (Baton Rouge, LA)
- …acknowledges physicians for their clinical excellence and effective utilization of health care resources. Reporting to the Executive Behavioral Health ... members across Aetna. **Expectations and Responsibilities:** * Serve as the principal utilization management reviewer for cases related to Applied Behavior… more
- Highmark Health (Baton Rouge, LA)
- …This role supports the full application product lifecycle for **clinical and utilization management software** , with a specific focus on driving ... function as a pivotal bridge, translating high-level **clinical and utilization management software** business needs into detailed...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Baton Rouge, LA)
- …:** **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
- Magellan Health Services (Shreveport, LA)
- …in healthcare, behavioral health , psychiatric and/or substance abuse health care setting. Strong organization, time management and communication skills. ... Knowledge of utilization management procedures, mental health and substance abuse community resources and providers. Knowledge and experience in inpatient… more
- Intermountain Health (Baton Rouge, LA)
- …referrals, and advocate for patient rights. Educates patients about their medical/ behavioral health conditions and self- management . + **Multidisciplinary ... approach referring and consulting with social work, nutrition, pharmacy, rehabilitation, behavioral health , etc. resources as appropriate. + **Relationship… more
- Highmark Health (Baton Rouge, LA)
- …impact corporate performance + Researches, manipulates, and prepares data related to Health Management programs that document program activities and the results ... the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role...of Health Management… more
- Ochsner Health (New Orleans, LA)
- …recognized Diabetes Self- Management Education and Support (DSMES) program for the health system. Works closely with diabetic patients to perform an assessment of ... other groups on topics related to diabetes education, disease prevention and management , and develops health improvement programs. + Recommends pharmacological… more
- CVS Health (Baton Rouge, LA)
- …. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health /Substance Abuse or Maternity/ Obstetrics experience.… more
- Highmark Health (Baton Rouge, LA)
- …supporting, and optimizing the architectural strategy for **all clinical and utilization management applications** . Their expertise spans application, solution, ... and AI integration, extending this strategic oversight across **all clinical and utilization management applications** . This involves ensuring the completeness… more
- Highmark Health (Baton Rouge, LA)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...measurable outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and… more
- Highmark Health (Baton Rouge, LA)
- …and mentorship in areas of expertise and architecture to peers, developers, management , and business users. **Key Responsibilities:** + Lead the design and ... application designs to ensure optimal technology selection, efficient resource utilization , and seamless system integration. + Ensure system architecture adheres… more
- Highmark Health (Baton Rouge, LA)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job plays a key role in ensuring projects (ie change initiatives) meet objectives on time ... and minimize risk to implementation. Works to drive faster adoption, higher ultimate utilization and greater proficiency of the changes that impact employees in the… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …or Registered Line Technician (RLT) + Experience supporting utilization management processes or working with Electronic Health Records/Systems _The Physical ... Coordinator is responsible for providing both administrative and clinical support in the behavioral health authorization process for ABA and Autism Services at… more
- Highmark Health (Baton Rouge, LA)
- …contribute to highest levels of performance. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities including, but limited to: involved in hiring and ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct, and control… more
- Louisiana Department of State Civil Service (Houma, LA)
- …South Central Louisiana Human Services Authority and will be located at the Terrebonne Behavioral Health Clinic. This position may be filled as an Unclassified ... commitment to the welfare of individuals and families with mental/ behavioral health issues + Knowledge of principles,...in a succinct and timely manner. + Consistently meets Utilization Management and billable services expectations +… more