- Humana (Annapolis, MD)
- …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- Humana (Annapolis, MD)
- …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 (Annapolis, MD)
- …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
- BrightSpring Health Services (Baltimore, MD)
- …including pharmacy, home health care and primary care, and rehabilitation and behavioral health , we provide comprehensive care and clinical solutions in all ... home health care, + Three years' experience in an administrative/supervisory/quality management role in a Medicare certified home health agency generally… more
- Highmark Health (Annapolis, MD)
- …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
- Elevance Health (Hanover, MD)
- …Maryland Medicaid, Carelon strives to enhance participant outcomes and efficiently manage behavioral health services throughout the State of Maryland. Carelon is ... Services leader with significant experience in managing large-scale programs within the behavioral health sector and a demonstrable history of ensuring customer… more
- Elevance Health (Hanover, MD)
- …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 (Annapolis, MD)
- …:** **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 (Annapolis, MD)
- …, 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 (Annapolis, MD)
- …(NCQA), Utilization Review Accreditation Committee (URAC), Pennsylvania Department of Health , Department of Labor, the Center for Medicare and Medicaid Services ... review and make determinations regarding physician reviewer assignments for medical management decisions. Cases requiring physician review are provider and member… more
- Highmark Health (Annapolis, MD)
- …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 (Annapolis, MD)
- …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
- Highmark Health (Annapolis, MD)
- …sales revenue and expanding market share through new client acquisition and relationship management . The ideal candidate will have a strong background in B2B sales, ... as: Financial Services, Utilities, Property and Casualty Insurance + CRM utilization **Preferred** + Transactional print and mail and digital delivery experience… more
- CareFirst (Baltimore, MD)
- …clinically related experience working in Care Management , Home Health , Discharge Coordination and/or Utilization Review. **Preferred Qualifications:** + ... of care utilizing experience and skills in **both** case management and utilization management . To...interventions, discharge planning and coordination to address member's medical, behavioral and/or social determinant of health needs… more
- CareFirst (Baltimore, MD)
- …nursing expert knowledge and all available clinical information for both medical and behavioral health conditions, as well as medical policies, to determine if ... Upon Hire Preferred **Preferred Qualifications:** + 2 years' experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross… more
- University of Maryland, Baltimore (Baltimore, MD)
- …the command and control of the Emergency Operations Center (EOC), the Emergency Management Team (EMT) and Behavioral Evaluation Threat Assessment Team (BETA). ... 3 personal leave, unlimited accrual of sick time, and comprehensive health insurance; professional learning and development programs; tuition remission for employees… more
- The Cigna Group (Baltimore, MD)
- …several health -related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, ... of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including...and Coordination** 1. Participation in weekly care coordination with health plan case management as directed by… more
- Immigration and Customs Enforcement (Baltimore, MD)
- …and patients deemed incompetent per designated process. Collaborates with the Behavioral Health Unit (BHU) for notification and ongoing monitoring ... Practitioner/Physician Assistant), preferably in correctional or detention setting. Case management and utilization review experience preferred. Correctional… more
- NASCO (Annapolis, MD)
- …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 (Annapolis, MD)
- …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