- Humana (Richmond, VA)
- …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 (Richmond, VA)
- …a part of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within… more
- Elevance Health (Richmond, VA)
- **Director Behavioral Health Program and Services** **Location:** Alternate locations may be considered. This position will work a hybrid model (remote and ... the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health ...care programs and services, such as Employee Assistance Programs, Utilization Management and Crisis Calls. Works in… more
- CenterWell (Richmond, VA)
- …training education spanning onboarding to continuing education. **Role Description** The LCSW Behavioral Health Educator will be embedded within the clinical ... team and will oversee training aspects of the cognitive behavioral health screenings, psychosocial assessments, techniques that...has a deep understanding of all the High-risk program management roles and gains the respect and confidence of… more
- Molina Healthcare (Richmond, VA)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... performing one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.),… more
- Humana (Richmond, VA)
- …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
- CVS Health (Richmond, VA)
- … health care innovators. The Engagement Outreach Hub Care Management Associate supports comprehensive coordination of healthcare services through telephonic ... At CVS Health , we're building a world of health...with heart, each and every day. Aetna's Medicaid Care Management Engagement Outreach Hub is a new initiative focused… more
- Highmark Health (Richmond, VA)
- …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
- HCA Healthcare (Richmond, VA)
- …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 ... like family! Jump-start your career as a Director Clinical Quality Resource Management today with HCA Healthcare. **Benefits** HCA Healthcare, offers a total rewards… more
- Highmark Health (Richmond, VA)
- …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
- Highmark Health (Richmond, VA)
- …:** **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 (Richmond, VA)
- …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 (Richmond, VA)
- …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 (Richmond, VA)
- …(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
- ChenMed (Colonial Heights, VA)
- …physical exam, diagnosis and treatment, development of the plan of care, health education, specialty referrals, case management referrals, follow-up and clear ... Readmission Rate Advance directives/End of Life Planning Patient Satisfaction Utilization /Financial Management -managing resource utilization and… more
- ChenMed (Richmond, VA)
- …physical exam, diagnosis and treatment, development of the plan of care, health education, specialty referrals, case management referrals, follow-up and clear ... informed decisions re: goals of care, palliative care and hospice. + Utilization /Financial Management -managing resource utilization and reimbursement for… more
- Bon Secours Mercy Health (Midlothian, VA)
- At Bon Secours Mercy Health , we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and ... and patient-focused organization, Bon Secours exists to enhance the health and well-being of all people in mind, body...and skill based on principles of the biological, physical, behavioral , and social sciences + Application of the nursing… more
- Bon Secours Mercy Health (Petersburg, VA)
- At Bon Secours Mercy Health , we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and ... operational excellence. **_Southside Regional Medical Center is your community health care provider, a 300-bed facility located on a...and skill based on principles of the biological, physical, behavioral , and soci al sciences * Application of the… more
- Bon Secours Mercy Health (Mechanicsville, VA)
- 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
- Highmark Health (Richmond, VA)
- …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