- Humana (Springfield, IL)
- …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
- Centene Corporation (Springfield, IL)
- …workplace flexibility. **THIS POSITION IS REMOTE/WORK FROM HOME SUPPORTING ILLINOIS MEDICAID BEHAVIORAL HEALTH . WILL WORK CENTRAL TIME ZONE HOURS.** **WORK ... million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified,...regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
- Evolent Health (Springfield, IL)
- …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
- CVS Health (Springfield, IL)
- …* Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate ... care issues through established channels * Ability to speak to medical and behavioral health professionals to influence appropriate member care. * Utilizes… more
- Centene Corporation (Springfield, IL)
- …functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate,… more
- CVS Health (Springfield, IL)
- …as well as be the health plan's subject matter expert in medical management operations, including Utilization Management , Care Management , Care ... program development and implementation, Social Determinants of Health programs, Behavioral Physical Health ...services and the enterprise broadly. + Overseeing the analysis, management , execution and staffing for all health … more
- Highmark Health (Springfield, IL)
- …:** **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
- Highmark Health (Springfield, IL)
- …:** **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 (Springfield, IL)
- **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
- Highmark Health (Springfield, IL)
- …**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 (Springfield, IL)
- …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 (Springfield, IL)
- …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 (Springfield, IL)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** As Marketing Technology Manager, you will be the technological cornerstone of our marketing & ... utilizing these tools for a range of applications from campaign management to strategic decision-making. **ESSENTIAL RESPONSIBILITIES** + Lead the design,… more
- Humana (Springfield, IL)
- …of clinical conditions and disease states, such as oncology, falls, palliative care, behavioral health and/or other chronic conditions + Deep understanding of ... payer economics, and/or other specific healthcare areas such as EMR, Episode grouper, utilization management , value-based care, low value care etc. + Familiarity… more
- Humana (Springfield, IL)
- …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