- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Registered Nurse, LICSW, LMHC + 3-5 years of clinical experience in Behavioral Health Care settings + Utilization Management experience preferred + CCM ... your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care ...dedicated and motivated team of professionals, including medical and behavioral health care managers, dieticians,… more
- Spokane County (Spokane, WA)
- …Health Administrative Service Organization Integrated Care and the Behavioral Health Administrative Services Organization Utilization Review ... Behavioral Health Administrative Services Organization Utilization Review Integrated Care Coordinator: + Performs...management, utilization review, or concurrent review of behavioral health inpatient and outpatient care… more
- CVS Health (Columbus, OH)
- …+ Experience in a behavioral health inpatient setting + Managed care experience + Utilization review experience + Ability to multitask, prioritize and ... treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. Utilizes… more
- BronxCare Health System (Bronx, NY)
- …Qualifications Minimum of three (3) years experience specifically in Behavioral Health Utilization review and casemanagement.Managed Care or Discharge ... Overview The Coordinator- Behavioral Health Utilization Management...identifying delays/barriers to discharge. Knowledge of Medicare, Medicaid, Managed Care and OASIS guidelines, medicalnecessity criteria pertaining to psychiatry… more
- CVS Health (Charleston, WV)
- …appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. + ... or certification + 3+ years clinical practice experience in behavioral health , eg, hospital setting, residential setting, alternative care setting, or… more
- CVS Health (Phoenix, AZ)
- …appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and ABA. Utilizes clinical experience and skills in ... **Required Qualifications** + Active and unrestricted RN license or behavioral health license in the state of...the Arizona Medicaid Health system + Managed care experience + Utilization review experience +… more
- Sutter Health (Berkeley, CA)
- …from accidental, intentional, or inappropriate disclosure. **DEPARTMENT REQUIRED EDUCATION** Department, Behavioral Health : Master's in Social Work or related ... Collaborate with case managers, clinical nursing staff and others to ensure appropriate utilization and quality care through utilization review, tracking and… more
- Pipeline Health System, LLC (Toast, NC)
- Job Title: Utilization Review Registered Nurse- Behavioral Health Unit/FT/Days Job Summary: This Utilization Review (UR) Registered Nurse (RN) position ... to our patients. This position is responsible for utilization review, assessment of discharge planning needs and coordination...with the team members who are recognized leaders within health care . Education: + Bachelor's degree in… more
- CVS Health (Tallahassee, FL)
- …treatment, evidence-based care and clinical practice guidelines for Behavioral Health , specific to Behavior Analysis. Utilizes clinical experience ... 3+ years of clinical practice experience (eg, hospital or behavioral health setting, Autism treatment and BA...Medicaid Health system strongly preferred + Managed care experience + Utilization review experience +… more
- Humana (Columbus, OH)
- …us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral ... communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional...millions of people we serve to achieve their best health - delivering the care and service… more
- Centene Corporation (Jefferson City, MO)
- …in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of ... licensure as outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and ability to review… more
- AdventHealth (Glendale Heights, IL)
- …701 Winthrop Ave, Glendale Heights, IL **The role you'll contribute:** Provides health care services regarding admissions, case management, discharge planning ... to succeed:** + Diploma from an accredited school/college of nursing required. + Behavioral Health RN experience strongly preferred + Experience in … more
- Stanford Health Care (Palo Alto, CA)
- …preventive care , telemedicine through Teledoc, prescription drug coverage, and behavioral health coverage. Additional incentives exist for healthy choices. ... of America) Why work at Stanford Medicine | Stanford Health Care (SHC)? Here is your opportunity...assistance! **This is an onsite Stanford Health Care job.** **A Brief Overview** The Utilization … more
- Magellan Health Services (Boise, ID)
- …in healthcare, behavioral health , psychiatric and/or substance abuse health care setting. Strong organization, time management and communication skills. ... other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse... utilization data. Assists with discharge planning and care coordination. Provides member assistance with mental health… more
- McLaren Health Care (Indianapolis, IN)
- …leading our organization forward. McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high ... Michigan-based health plan dedicated to meeting the health care needs of each of our...policy, utilization of standard screening techniques, and utilization of behavioral change techniques. Works with… more
- Commonwealth Care Alliance (Boston, MA)
- …improvement. + Minimum five (5) years of clinical experience in medical or behavioral health care delivery **Required Knowledge, Skills & Abilities:** ... develop and advance the UM program, collaborates with the Behavioral Health UM team the multiple clinical...to utilization management + Demonstrated knowledge of health care industry trends, developments and issues.… more
- Covenant Health Inc. (Louisville, TN)
- …appropriate committee(s). + Performs Quality Improvement functions within the Peninsula Behavioral Health system. + Attends workshops, seminars, and in-services ... and evaluation of program policies and criteria within Peninsula Behavioral Health . + Assists in the formulation... Health . + Assists in the formulation of health service utilization and cost forecasts with… more
- CVS Health (Oklahoma City, OK)
- …channels. + Ability to speak to medical and behavioral health professionals to influence appropriate member care . + Utilizes influencing/motivational ... care or outpatient clinic/facility) + Must complete the Behavioral Health Case Manager certification training provided...+ 1+ year(s) of crisis intervention experience + Managed care / utilization review experience + Case management and… more
- Elevance Health (FL)
- …+ Prior utilization management experience preferred. + Prior managed care experience preferred. + Experience with Applied Behavioral Analysis (ABA)/ ... candidate must live within 50 miles of an Elevance Health PulsePoint office. This utilization management role...Requires MA/MS in social work counseling or a related behavioral health field or a degree in… more
- CVS Health (Austin, TX)
- …in the development of clinical practice standards, policies, and procedures. - Behavioral health care management performance and coordination with ... meetings when requested. - Oversight and implementation of the utilization management program for behavioral health...guidelines. - Advocate for and implement innovative approaches to behavioral health care , promoting evidence-based… more