- Humana (Providence, RI)
- …Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC), RN ( Registered Nurse ) or other behavioral health professional licenses. ... and help us put health first** Humana Healthy Horizons is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral … more
- Humana (Providence, RI)
- …on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health. + Registered Nurse or Behavioral Health ... + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + Demonstrated excellent time… more
- Sharecare, Inc. (Providence, RI)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... with the participants and their Primary Care Provider according to the disease management program intervention guidelines. An RN is supervised by an Operations… more
- Highmark Health (Providence, RI)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Highmark Health (Providence, RI)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... required depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case … more