- 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
- CVS Health (Jefferson City, MO)
- …coordinate, document and communicate all aspects of the utilization /benefit management program for preauthorization for mental health services. Applies ... clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus… more
- Centene Corporation (Jefferson City, MO)
- …as mental health parity, community services overutilization, prior authorization, and utilization management reform. + Serve as the internal subject matter ... as mental health parity, community services overutilization, prior authorization, and utilization management reform. + Analyze data related to behavioral … 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
- Humana (Jefferson City, MO)
- …such as provider relations, claims submission and payment, utilization management processes, behavioral health processes, and dispute resolution. ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Senior...educational material, or trainings. + 3+ years of project management experience with mid-size projects. + 2+ years of… more
- Highmark Health (Jefferson City, MO)
- …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
- Highmark Health (Jefferson City, MO)
- …in addition to 3 weekdays** 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
- HCA Healthcare (Kansas City, MO)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... hours impacting our communities. As a Manager of Case Management with Research Medical Center, you can be a...Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… 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
- HCA Healthcare (Kansas City, MO)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The...and family needs with the efficacious and cost effective utilization of resources + Serves as a transplant social… more
- Elevance Health (St. Louis, MO)
- …for over 150 years. With capabilities spanning pharmacy, behavioral health , complex care delivery, medical benefits management , payment integrity, palliative ... risk solution spans 100% of the total cost of care for our patients, integrating utilization management , care management , pharmacy management , and data… more
- Elevance Health (St. Louis, MO)
- …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 (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 , and Long-Term Services and Supports. Key responsibilities include: + Lead the development of actionable go-to-market… more
- HCA Healthcare (Kansas City, MO)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... you have the career opportunities as a(an) Director Case Management you want with your current employer? We have...Center offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- Peoples Health Centers Family of Companies (St. Louis, MO)
- …needs. * Contributes to development of a recovery oriented care plans that address behavioral health , medical, and social barriers for persons served. The plans ... success. * Helps the client increase his/her support network outside of the behavioral health service delivery system. * Participate in weekly ERE Outreach… more
- Tri-County Mental Health Services (Kansas City, MO)
- …and professional meetings to keep abreast of best practice models for integration of behavioral health and primary health continuity of care. * Other ... and state-required insurance coverage **Experience Required:** * Minimum of 3 to 5 years behavioral health (mental health and substance use) and supervisory… more
- Highmark Health (Jefferson City, MO)
- …, 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
- BrightSpring Health Services (St. Louis, MO)
- …including pharmacy, home health care and primary care, and rehabilitation and behavioral health , we provide comprehensive care and clinical solutions in all ... Our Company BrightSpring Health Services Overview The Talent Acquisition team works...the company or campus + Utilizes competencies in sourcing, behavioral interviewing, selection, and effective utilization of… more
- CenterWell (Kansas City, MO)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... part of our caring community and help us put health first** The Market CMO serves as a ...expertise. + Develop, implement, and monitor the outcomes of utilization review and disease management programs to… more