- Highmark Health (Santa Fe, NM)
- …the effective utilization management strategies including: review of appropriateness of health care services, application of criteria to assure appropriate ... of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members...established industry and corporate standards and are within the care manager 's professional discipline. Effectively function in… more
- Evolent (Santa Fe, NM)
- …providing better health outcomes for this population. **What You'll Be Doing:** + The Behavioral Health Case Manager (LCSW or LMHC) will connect with the ... , we seek to connect the pieces of fragmented health care system and ensure people get...or Registered Nurse (RN), Required + 3-5 years of behavioral health experience, preferably in a hospital,… more
- Highmark Health (Santa Fe, NM)
- …Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company ... times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice… more
- CAI (Santa Fe, NM)
- …implement and evaluate care for eligible members with chronic and complex health care , social service and custodial needs in a nursing facility or ... address the member's specific needs. + Educate members or caregivers regarding health care needs, available benefits, resources and services including available… more
- Molina Healthcare (Santa Fe, NM)
- …for regular outreach and management. + Promotes integration of services for members including behavioral health care and long term services and supports to ... delivery of care across the continuum, including behavioral health and long term care...Worker (LCSW), Advanced Practice Social Worker (APSW), Certified Case Manager (CCM), Certified in Health Education and… more
- Highmark Health (Santa Fe, NM)
- …, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals ... ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs… more
- Magellan Health Services (Santa Fe, NM)
- …as appropriate. + Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions ... of care regularly to identify gaps in care , trends to improve health and quality...issues, specific member needs and disease processes whether, medical, behavioral , social, community based or long term care… more
- Highmark Health (Santa Fe, NM)
- …relationship management and performance + Experience in Indirect Category Sourcing and/or Health Care Sourcing with demonstrated expertise in influencing the ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job...Certified Professional in Supply Management (CPSM) + Certified Purchasing Manager (CPM) **SKILLS** + Experience in strategic management and… more
- Highmark Health (Santa Fe, NM)
- …for analyzing clinical data to assess potential stop loss and managed care claim liability, utilizing Case Management oversight techniques to ensure front line ... + Analyze clinical data to assess potential stop loss and managed care claim liability and utilize Case Management oversight techniques to ensure front… more
- Compass Group, North America (Santa Fe, NM)
- Morrison Healthcare We are hiring for a Clinical Nutrition Manager position in Santa Fe, NM. $10K sign-on bonus and relocation assistance offered! + Location : ... St. Vincent Regional Medical Center + Setting : Acute Care + Schedule : Full time, Monday - Friday...the latest in healthful eating and an understanding of behavioral change in food consumption. Morrison's alignment with Partnership… more
- J&J Family of Companies (Santa Fe, NM)
- Johnson & Johnson is recruiting for a field-based Site Activation CAR-T Senior Manager , Cell Therapy Experience Lead to support the United States. This is a field ... close proximity to a major metropolitan airport. At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a… more
- Sharecare (Santa Fe, NM)
- …coordinates with the Primary Care Provider and all other members of the health care team to support appropriate total healthcare management and ensure cost ... in the appropriate stratification level. + Identifies participant barriers to accessing health care services. Coordinates with Provider Service Managers and/or… more
- Highmark Health (Santa Fe, NM)
- …in special committee meetings as required. + Cooperates with other health care team members and the Operations Manager pursuant to the Allegheny ... timely manner. + Patients are appropriately referred to other health care support systems or community resources...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Santa Fe, NM)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** We are on a mission to deliver remarkable health experiences, freeing people to be their ... requires an advanced 360 person-centered approach to deliver the right message, guidance, care , outcome, and experiences, all at the right time. This Sr Application… more
- Highmark Health (Santa Fe, NM)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** We are on a mission to deliver remarkable health experiences, freeing people to be their ... requires an advanced 360 person-centered approach to deliver the right message, guidance, care , outcome, and experiences, all at the right time. This Sr level role… more
- Evolent (Santa Fe, NM)
- …Working across specialties and primary care , we seek to connect the pieces of fragmented health care system and ensure people get the same level of care ... medical reviews: LVNs, LPNs, and RNs along with our behavioral health reviewers: LMSWs, LCSW, and LPCs,...either requesting or submitting prior authorization requests. Or relevant health care experience in claims or appeal… more
- CenterWell (Santa Fe, NM)
- …impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... time with patients, providing compassionate, personalized care that brings better health outcomes. We...care , one of the largest providers of home health services, and fourth largest pharmacy benefit manager… more
- Evolent (Santa Fe, NM)
- …Working across specialties and primary care , we seek to connect the pieces of fragmented health care system and ensure people get the same level of care ... proprietary system generates cases for both the medical and behavioral health reviewers. These requests may be...either requesting or submitting prior authorization requests and/or relevant health care experience in claims or appeal… more
- Molina Healthcare (Santa Fe, NM)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care , for members with high need ... staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of… more