- Humana (Columbus, OH)
- …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 (Columbus, OH)
- …applicants whose only acute care experience is in behavioral health ) **Preferred Qualifications** + 1+ years' experience Utilization Review experience ... Bring your heart to CVS Health . Every one of us at CVS ...care more personal, convenient and affordable. **Position Summary:** This Utilization Management (UM) Nurse Consultant role is… more
- Evolent (Columbus, OH)
- …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 (Columbus, OH)
- …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 (Independence, OH)
- …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
- Bon Secours Mercy Health (Lima, OH)
- …observation, record reviews, feedback and evaluations as required. The Behavioral Health Access Clinician participates in the safe management of the milieu, ... care assessments with patients who present to the Emergency Department needing behavioral health assistance. Works collaboratively with the Emergency Department… more
- Highmark Health (Columbus, OH)
- …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 (Columbus, OH)
- …issues. Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the ... **Required Qualifications** + Must be Ohio Resident. + Active Behavioral Health license in the state Ohio...BH Clinical License: LPCC, IMFT, or LISW + Managed care/ utilization review experience + Case management and… more
- Premier Health (Troy, OH)
- Position: ASSOCIATE NURSE MGR/ UTILIZATION REVIEW RN Dept: Inpatient Behavioral Health Shift: Full time 72 hours/pp: 7am-7:30pm Facility: Upper Valley ... Provides concurrent and retrospective reviews of patients admitted to the behavioral health inpatient unit. Completes pre-certification and re-certification of… more
- Bon Secours Mercy Health (Youngstown, OH)
- …and operational excellence. **Summary of Primary Function/General Purpose of Position** The Behavioral Health Registered Nurse (RN) functions as a care provider ... Collects and records nursing assessment of the physical and behavioral health status of the patient. *...patient outcomes are met. * Participates in the safe management of the milieu, intervening effectively with patients who… more
- Molina Healthcare (Columbus, OH)
- …Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health ... and chemical dependency services and assists with implementing integrated Behavioral Health care management programs....for utilization management and case management programs for mental health and chemical… more
- Humana (Columbus, OH)
- …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
- Bon Secours Mercy Health (Fairfield, OH)
- At Bon Secours Mercy Health , we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and ... directs patient teaching activities and coordinates the care provided by health team members. **Essential Job Functions** In collaboration with the interdisciplinary… more
- CVS Health (Columbus, OH)
- …state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health Plan / Payor ... and New Jersey offering a variety of physical and behavioral health programs and services to its...can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will… more
- Elevance Health (Columbus, OH)
- …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...of Internal, Family, Neonatal, and/or OBGYN strongly preferred. + Utilization management experience is a PLUS. Please… more
- Elevance Health (Cincinnati, OH)
- …as related to oncology drivers. Responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most ... Director** will be supporting our clients in operations with utilization and case management reviews. In addition,...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
- Highmark Health (Columbus, OH)
- …:** **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
- BrightSpring Health Services (Canton, OH)
- …Community Living, Adult Host Homes for adults regardless of disability, Behavioral /Mental Health Support, In-home Pharmacy Solutions, Telecare and Remote ... ResCare Community Living Overview This position plans, directs, and coordinates health services for all assigned service sites. Provides oversight and direction… more
- Elevance Health (Cincinnati, OH)
- …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 (Columbus, OH)
- …:** **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