- Humana (Richmond, VA)
- …+ Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health . + Registered Nurse or ... BSN degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + Demonstrated… more
- CVS Health (Richmond, VA)
- …of care, and appropriate discharge planning + Serve as the behavioral health subject matter expert to support care management staff in serving Aetna ... foster collaboration and provide education and training + Consults with Plan executive management regarding physical and behavioral health clinical issues as… more
- Humana (Richmond, VA)
- …Humana Healthy Horizons in Virginia is seeking a Learning Facilitator/Preceptor, Utilization Management (Learning Facilitation Professional 2) who will conduct ... staff understanding of training that was provided. + Supports precepting activities for Utilization Management staff. **Use your skills to make an impact**… more
- Humana (Richmond, VA)
- …value-based care, quality metrics, population health , and disease or care management . The Behavioral Health Medical Director may develop procedures, ... part of our caring community and help us put health first** The Behavioral Health ...management , utilization management , case management , discharge planning and/or home health or… more
- CVS Health (Richmond, VA)
- …community treatment resources, mental health managed care programs, and Aetna Behavioral Health policies and procedures, and criteria. - Interact with ... clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning,… more
- Elevance Health (Richmond, VA)
- …responsible for appeals reviews within our Medicaid and Medicare programs.** The ** Behavioral Health Medical Director** is responsible for the administration of ... behavioral health medical services, to ensure the...clinical reviews. + The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and… more
- HCA Healthcare (Richmond, VA)
- …Do you want to join an organization that invests in you as a(an) Behavioral Health Pract PRN? At Chippenham Hospital, you come first. HCA Healthcare ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free...next level of care. + Has working knowledge of utilization management functions and performs these duties… more
- CVS Health (Richmond, VA)
- …Utilizes skills to coordinate, document and communicate all aspects of the utilization /benefit management program. -Applies critical thinking and knowledge in ... Bring your heart to CVS Health . Every one of us at CVS ...and education for members through the use of care management tools and resources. Evaluation of Members; Through the… more
- CVS Health (Richmond, VA)
- …organization-wide business functions including claims, member services, compliance, quality, utilization management , and network/provider services. + Serve as ... Bring your heart to CVS Health . Every one of us at CVS ...5+ years of clinical practice experience in physical or behavioral healthcare. + 5+ years of management … more
- HCA Healthcare (Hopewell, 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 ... make a difference. We are looking for a dedicated Behavioral Health Team Lead like you to...members, payer representatives, and other parties as appropriate regarding behavioral services . Performs utilization review as… more
- Highmark Health (Richmond, VA)
- …for the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review. Ensures all accurate information is ... including verification of benefit eligibility. Build cases in the utilization management system. + Use knowledge of...0 - 1 year of experience working in the Health Insurance Industry **LICENSES AND CERTIFICATIONS** **Required** + None… 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
- Elevance Health (Colonial Heights, VA)
- …identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term ... chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. + Obtains a thorough and accurate… more
- Humana (Richmond, VA)
- …and subpopulations. Areas of focus include Care Management , Quality Improvement, Utilization Management , Population Health , Social Determinants of ... Health , Pharmacy, Behavioral Health , Institutional Long-Term Services and Supports (LTSS), Home and...Organization (MCO) focusing on Medicaid clinical strategy and population health management strategy. **Alternatively** **,** 5+ years… more
- Elevance Health (Richmond, VA)
- …locations.** The Medical Director is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most ... an equivalent background. For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years of experience providing … more
- Humana (Richmond, VA)
- …of care, quality management , utilization management , case management , discharge planning and/or home health or post-acute services such as inpatient ... health insurance, other healthcare providers, clinical group practice management . * Utilization management experience...and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral … more
- Highmark Health (Richmond, VA)
- **Company :** Highmark Health **Job Description :** Job Description **JOB SUMMARY** This role within the marketing & experience department will be at the forefront ... includes leveraging cutting-edge customer experience platforms, implementing robust data management solutions, and optimizing marketing automation tools to drive… more
- Elevance Health (Richmond, VA)
- …+ Previous case management experience is preferred. + Behavioral Health and/or experience working with individuals with intellectual/developmental ... disabilities is a huge plus. + Home health experience, utilization management and/or hospital discharge planning experience is a plus. more
- Bon Secours Mercy Health (Richmond, VA)
- At Bon Secours Mercy Health , we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and ... why we're proud to offer our **Bon Secours Mercy Health Nursing Flex Team** , to help our nurses...and skill based on principles of the biological, physical, behavioral , and social sciences + * Application of the… more
- Highmark Health (Richmond, VA)
- …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