- 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)
- …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)
- …positive outcomes and enhance overall well-being. What you will do + Coordinates behavioral health assessments to gain information on substance abuse history and ... measurable outcomes. + Configures electronic medical software to categorize behavioral health conditions by severity. + Edits...to deliver an impactful message surrounding client rights and health needs. + Examines the data management … more
- CVS Health (Richmond, VA)
- …treatment resources, mental health managed care programs, and Aetna Behavioral Health policies and procedures, and criteria.- Interact with Supervisors ... 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 (Hopewell, VA)
- **Description** Introduction Do you have the career opportunities as a Behavioral Health Counselor you want with your current employer? We have an exciting ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free...appropriate next level of care.7. Has working knowledge of utilization management and case management … more
- CVS Health (Richmond, VA)
- …health services. Coordinate with health plan staff (eg Member Services, Utilization Management , Care Management , Provider Network) to secure needed ... services for individual members In conjunction with health plan staff (eg Utilization Management...staff (eg Utilization Management , Care Management ) coordinate processes related to behavioral and… more
- CVS Health (Richmond, VA)
- …affordable. This is a full time remote teleworker position in Virginia supporting the behavioral health team. Travel is required; 25-40% of the time in Virginia. ... Bring your heart to CVS Health . Every one of us at CVS ...to coordinate, document and communicate all aspects of the utilization /benefit management program.-Applies critical thinking and knowledge… more
- CenterWell (Richmond, VA)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as… 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
- Highmark Health (Richmond, VA)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Richmond, VA)
- …Description :** **JOB SUMMARY** This job implements 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...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Elevance Health (Richmond, VA)
- …care plans by educating members regarding clinical needs and facilitating referrals to health professionals for behavioral health needs. + Uses motivational ... Management II** **$2000 Sign on Bonus** At **Federal Health Products and Services - FHPS** , a proud...for multiple managed conditions to ensure cost-effective and efficient utilization of health services. Conducts assessment, planning,… more
- Elevance Health (Richmond, VA)
- …PST.** The **Medical Director** is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most ... For Health Solutions and Carelon organizations (including behavioral health ) only, a minimum of 5...a State agency. **Preferred Skills, Capabilities, and Experiences:** + Utilization Management experience is a plus. +… 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
- Molina Healthcare (Glen Allen, 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
- 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
- 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
- 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