- Humana (Charleston, WV)
- …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 (Charleston, WV)
- …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
- CenterWell (Charleston, WV)
- …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
- Humana (Charleston, WV)
- …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 (Charleston, WV)
- …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 (Charleston, WV)
- …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
- BrightSpring Health Services (Dunbar, WV)
- …Community Living, Adult Host Homes for adults regardless of disability, Behavioral /Mental Health Support, In-home Pharmacy Solutions, Telecare and Remote ... ResCare Community Living Overview This position plans, directs, and coordinates health services for all assigned service sites. Provides oversight and direction… more
- Highmark Health (Charleston, WV)
- …:** **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 (Charleston, WV)
- …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 (Charleston, WV)
- …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 (Charleston, WV)
- …(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 (Charleston, WV)
- …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
- CenterWell (Charleston, WV)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... **Become a part of our caring community and help us put health first** The Clinical Pharmacy Technician 4 assists the interdisciplinary CIT team with… more
- CenterWell (Charleston, WV)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... **Become a part of our caring community and help us put health first** The Senior Strategy Advancement Professional provides data-based strategic direction to… more
- Humana (Charleston, WV)
- …of clinical conditions and disease states, such as hypertension, diabetes, kidney care, behavioral health and/or other chronic conditions + Deep understanding of ... part of our caring community and help us put health first** Humana's Clinical Analytics Team is seeking a...other specific healthcare areas such as EMR, Episode grouper, utilization management , value-based care, low value care… more