- Humana (Springfield, IL)
- …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
- Humana (Springfield, IL)
- …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
- CVS Health (Springfield, IL)
- …meetings in Chicago/Downer's Grove area.** **Position Summary** The Clinical Case Manager, Behavioral Health , is responsible for driving and supporting care ... care management activities with members to ensure that their medical and behavioral health needs are met and to enhance the member's overall wellness.… more
- CVS Health (Springfield, IL)
- …*Minimum 2 years of direct clinical practice experience post masters in Behavioral Health *Minimum 1+ year of Case Management experience *Willing and able to ... and/or trainings in Downers Grove IL as needed/requested by Management .** Preference for candidates residing in the Chicago area....activities with members to evaluate the medical needs and behavioral health needs of the member to… more
- Highmark Health (Springfield, IL)
- …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 (Springfield, IL)
- …as well as be the health plan's subject matter expert in medical management operations, including Utilization Management , Care Management , Care ... program development and implementation, Social Determinants of Health programs, Behavioral Physical Health ...services and the enterprise broadly. + Overseeing the analysis, management , execution and staffing for all health … more
- CVS Health (Springfield, IL)
- …- Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate ... care issues through established channels - Ability to speak to medical and behavioral health professionals to influence appropriate member care. - Utilizes… more
- Highmark Health (Springfield, IL)
- …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
- Highmark Health (Springfield, IL)
- …:** **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
- Highmark Health (Springfield, IL)
- …, 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
- Highmark Health (Springfield, IL)
- …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
- Highmark Health (Springfield, IL)
- …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
- Humana (Springfield, IL)
- …innovative **Value Based Program** models for range of provider types, such as behavioral health , maternity, specialists, and social determinants of health , ... **Become a part of our caring community and help us put health first** The Value-Based Programs Lead supports successful value-based provider relationships with a… more
- NASCO (Springfield, IL)
- …wide (or Plan Enterprise) implementation of product capabilities related to data management and membership or billing processing subsystems. This role aids Plan ... system and assists in defining the development standards, programming, troubleshooting and management of problems affecting IT software to help sustain the highest… more
- Humana (Springfield, IL)
- …opportunities which may support Member Engagement, Clinical Performance, Provider Engagement, Behavioral Health and Pharmacy. This position reports to Quality ... part of our caring community and help us put health first** The Senior Data and Reporting Professional generates...role is to develop organized analytics, reports and data management to support the market's Quality team within the… more
- Humana (Springfield, IL)
- …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