- Humana (Columbus, OH)
- …help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
- CVS Health (Columbus, OH)
- …applicants whose only acute care experience is in behavioral health ) **Preferred Qualifications** + 1+ years' experience Utilization Review experience ... Bring your heart to CVS Health . Every one of us at CVS ...care more personal, convenient and affordable. **Position Summary:** This Utilization Management (UM) Nurse Consultant role is… more
- Evolent (Columbus, OH)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Evolent (Columbus, OH)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Intake … more
- Elevance Health (Columbus, OH)
- …companies, Carelon Behavioral Health , offers superior clinical mental health and substance use disorder management , a comprehensive employee assistance ... and insightful analytics to improve the delivery of care._ ** Behavioral Health Care Manager II - Applied...is licensed staff supervision. + Previous experience in case management / utilization management with a broad… more
- Highmark Health (Columbus, OH)
- …Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care services, ... utilization , identification of opportunities for referral to a Health Coach/case management , and identification and resolution...years of post licensure experience in a combination of Behavioral Health Clinical, Case Management … more
- CVS Health (Columbus, OH)
- …issues. Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the ... **Required Qualifications** + Must be Ohio Resident. + Active Behavioral Health license in the state Ohio...BH Clinical License: LPCC, IMFT, or LISW + Managed care/ utilization review experience + Case management and… more
- Molina Healthcare (Columbus, OH)
- …Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health ... and chemical dependency services and assists with implementing integrated Behavioral Health care management programs....for utilization management and case management programs for mental health and chemical… more
- Veterans Affairs, Veterans Health Administration (Grove City, OH)
- …programs/degrees are not creditable as related degrees. Preferred Experience: One year Behavioral Health experience. Reference: For more information on this ... Summary The Outpatient Mental Health (MH) Registered Nurse (RN) promotes personal growth...for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care.… more
- CVS Health (Columbus, OH)
- …state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health Plan / Payor ... and New Jersey offering a variety of physical and behavioral health programs and services to its...can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will… more
- Highmark Health (Columbus, OH)
- …:** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent assesses ... coverage, creation of a prior authorization case 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 (Columbus, OH)
- …for over 150 years. With capabilities spanning pharmacy, behavioral health , complex care delivery, medical benefits management , payment integrity, palliative ... risk solution spans 100% of the total cost of care for our patients, integrating utilization management , care management , pharmacy management , and data… more
- Elevance Health (Columbus, OH)
- …A proud member of the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health Options, offers superior clinical mental ... preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For… more
- Highmark Health (Columbus, OH)
- …:** **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 (Columbus, OH)
- …, physician practice management or clinical operations, ancillary provider management or clinical operations, and/or health insurance) with significant ... knowledge of and experience with various care delivery models + Experience in health plan provider network performance management , care/case management ,… more
- Highmark Health (Columbus, OH)
- …**SKILLS** + Driving technology sales + Background on IT + Background in Care Management , Utilization Management , and Digital Products and Services + ... channel growth for enGen. Work closely with marketing, sales engineering and product management to deliver on targets, objectives and provide a voice of the partner.… more
- Highmark Health (Columbus, OH)
- …to deliver financial results to the Enterprise. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the… more
- Highmark Health (Columbus, OH)
- …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
- Highmark Health (Columbus, OH)
- …in business terms and values. + Manage expectations of customers and management . + Represent various architectural disciplines in customer reviews and planning, ... in their areas of expertise and architecture to peers, developers, management and business users including technical expertise, coaching and ad-hoc training.… more
- Highmark Health (Columbus, OH)
- …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