- Humana (Nashville, TN)
- …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
- CVS Health (Nashville, TN)
- …+ 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
- Humana (Nashville, TN)
- …clinical services . Experience in utilization management review and case management in a health plan setting . No current sanction from Federal or ... part of our caring community and help us put health first** The Behavioral Health ...a focus on collaborative business relationships, value-based care, population health , or disease or care management +… more
- Highmark Health (Nashville, TN)
- …account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and case/ disease management ... information to improve individual outcomes as an adjunct to health coaching. If acting in the capacity as a...review. + Assist in the development and implementation of utilization management programs including but not limited… more
- Highmark Health (Nashville, TN)
- …Description :** **JOB SUMMARY** This job captures all inbound inquires for utilization management review from providers and pharmacies. The incumbent assesses ... and then creates the case (data entry) 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
- Elevance Health (Nashville, TN)
- …for over 150 years. With capabilities spanning pharmacy, behavioral health , complex care delivery, medical benefits management , payment integrity, palliative ... involved in Utilization Management , Specialty Benefits Management , Payment Integrity, Advocacy, Health Plan Subrogation, Behavioral Health , … more
- Highmark Health (Nashville, TN)
- …:** **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
- HCA Healthcare (Hendersonville, TN)
- …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 ... organization that invests in you as a(an) Director Case Management ? At TriStar Hendersonville Medical Center, you come first....Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- HCA Healthcare (Nashville, TN)
- …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 Air Med ... Do you have the career opportunities as a Case Management RN you want in your current role? We...Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- HCA Healthcare (Nashville, TN)
- …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 volunteering in our communities. As a Manager Access Management with HCA Healthcare you can be a part...Healthcare offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- HCA Healthcare (Nashville, TN)
- …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 volunteering in our communities. As a(an) Manager Change Management with HCA Healthcare you can be a part...Healthcare, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- HCA Healthcare (Nashville, TN)
- …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 ... care like family! Jump-start your career as a Case Management Senior Manager today with HCA Healthcare. **Benefits** HCA...Healthcare, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- Elevance Health (Nashville, TN)
- … health care program in which members' needs are identified, including physical health , behavioral health , social services for a special product/programs ... Skills, Capabilities and Experiences:** Service delivery coordination, discharge planning, or behavioral health experience in a managed care setting preferred.… more
- Highmark Health (Nashville, TN)
- …assigned portfolios. Responsibilities include driving operational excellence, leading change management , fostering innovation to improve product health , ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This senior...contributing to product transformation and maturity, and strategic utilization of value levers toward outcomes. This involves identifying… more
- Highmark Health (Nashville, TN)
- …for content creation, identification of customer needs, development, and effective utilization of wellness/population health campaigns and initiatives designed ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job...clinical initiatives/programs to the customer audiences through effective project management , collaboration and application of best practices and engagement.… more
- Highmark Health (Nashville, TN)
- …(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 (Nashville, TN)
- …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
- HCA Healthcare (Nashville, TN)
- …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 ... HealthTrust, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The...working closely with clients to obtain all required spend, utilization data, and contract terms in order to complete… more
- HCA Healthcare (Nashville, TN)
- …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 ... Healthcare, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The...satisfaction goals within a deadline + Knowledge of case management and/or utilization review preferred + Ability… more
- HCA Healthcare (Nashville, TN)
- …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 ... Healthcare, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The...Compliance policies, and quality initiatives as it relates to utilization management . + Works directly with CM… more