• Utilization Management

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …years of clinical experience in Behavioral Health Care settings + Utilization Management experience preferred + CCM or other applicable certification(s) ... your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care...and BCBSMA policies and procedures + Focus on efficient utilization management with emphasis on discharge planning… more
    Blue Cross Blue Shield of Massachusetts (10/25/24)
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  • Integrated Care Coordinator (SCRBH) - Youth…

    Spokane County (Spokane, WA)
    …Care Coordinator: + Performs utilization management , utilization review , or concurrent review of behavioral health inpatient and outpatient ... Integrated Care and the Behavioral Health Administrative Services Organization Utilization Review Integrated Care. TOTAL COMPENSATION: $85,812 - $120,126… more
    Spokane County (10/13/24)
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  • Medical Director - Behavioral Health…

    CVS Health (Austin, TX)
    …other agency/stakeholder meetings when requested. - Oversight and implementation of the utilization management program for behavioral health services, ... TX's (ABHT) leadership team and is responsible for * Leadership and counsel for utilization management * Leadership and participation in case management more
    CVS Health (08/27/24)
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  • Medical Director - Behavioral Health…

    CVS Health (Baton Rouge, LA)
    …other agency/stakeholder meetings when requested. * Oversight and implementation of the utilization management program for behavioral health services, ... over/under- utilization . * Ensuring consistency in the application of utilization management standards, including those implemented by subcontracted entities… more
    CVS Health (09/10/24)
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  • Manager II Behavioral Health Services

    Elevance Health (Cerritos, CA)
    The **Manager II Behavioral Health Services** is responsible for Behavioral Health Utilization Management (BH UM), or Behavioral Health Case ... with facility-based and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience, which includes a minimum of 2… more
    Elevance Health (10/09/24)
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  • RN Case Manager Utilization

    HCA Healthcare (Richmond, VA)
    …growth, we encourage you to apply for our Case Manager Behavioral Utilization Management opening. We promptly review all applications. Highly qualified ... like family! Jump-start your career as a(an) Case Manager Behavioral Utilization Management today with...in evaluating medical necessity. + Performs admission and concurrent review for all payors and maintains legible documentation as… more
    HCA Healthcare (10/22/24)
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  • Clinical Reviewer - Behavioral

    Kepro (AR)
    …services based on review of clinical records. Preferred Qualifications/Experience: + Utilization Review / Utilization Management experience. + Clinical ... the public sector. Acentra is looking for a Clinical Reviewer - Behavioral Health - PRN (Remote... behavioral health utilization reviews or behavioral health case management . + Ability to… more
    Kepro (10/21/24)
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  • Behavioral Health Clinician…

    Molina Healthcare (Bowling Green, KY)
    …a Registered Nurse or Licensed Social Worker with PSYCH / BH Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines._** ... plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS… more
    Molina Healthcare (10/12/24)
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  • Utilization Clinical Reviewer

    Kepro (Anaheim, CA)
    Acentra seeks a Utilization Clinical Reviewer to join our growing team in California. Job Summary As a Utilization Clinical Reviewer , you'll harness your ... for ensuring the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process in alignment with the California Mental Health Services Authority… more
    Kepro (09/27/24)
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  • Coord- Behavioral Health Ult Mg

    BronxCare Health System (Bronx, NY)
    Overview The Coordinator- Behavioral Health Utilization Management (BH-UMC) will review and monitor all patientsadmitted into psychiatry or substance ... according to nationally recognizedcriteria. Responsibilities The Coordinator- Behavioral Health Utilization Management (BH-UMC) will review and monitor… more
    BronxCare Health System (09/18/24)
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  • Clinical Reviewer III (Baton Rouge, LA…

    Magellan Health Services (Baton Rouge, LA)
    management and verbal and written communication skills. Knowledge of utilization management procedures, Medicaid benefits, community resources and providers. ... care setting. Also requires minimum of 4 years of experience conducting utilization management according to medical necessity criteria. General Job Information… more
    Magellan Health Services (11/01/24)
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  • Psychologist Reviewer

    Centene Corporation (Olympia, WA)
    …Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
    Centene Corporation (10/30/24)
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  • Director, Behavioral Health, Health Plans

    VNS Health (Manhattan, NY)
    …and implementation of the behavioral health sections of the Quality Management (QM)/ Utilization Management (UM) Plan. Oversees the administration of ... implements, monitors and evaluates Utilization and Care Management metrics specific to Behavioral health services...community's needs. + Oversees the implementation and monitoring of utilization review and quality management more
    VNS Health (09/04/24)
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  • Utilization Review Clinician…

    Centene Corporation (Olympia, WA)
    …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... LA** ** Behavioral experience required** **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse. Monitors… more
    Centene Corporation (10/31/24)
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  • Utilization Review Coordinator

    Behavioral Center of Michigan (Warren, MI)
    …and reporting of complex clinical data and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's ... Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation… more
    Behavioral Center of Michigan (10/22/24)
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  • UM Coordinator - Utilization Review

    Hackensack Meridian Health (Belle Mead, NJ)
    utilization of resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of ... Management Coordinator utilizes clinical knowledge and understanding of behavioral health resource management to review...to the treatment team, Director of Utilization Management , and the Medical Director. + Review more
    Hackensack Meridian Health (10/28/24)
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  • Utilization Review Specialist

    Sutter Health (Berkeley, CA)
    …systems for the appeal/denial process, tracks and trends data, and coordinates utilization management activities for the assigned area. Collaborates with ... and others to ensure appropriate utilization and quality care through utilization review , tracking and evaluation and objectively compare criteria with… more
    Sutter Health (10/24/24)
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  • Utilization Review Clinician- ABA

    Centene Corporation (Tallahassee, FL)
    …assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare ... the applicable state required. Master's degree for behavioral health clinicians required. Behavioral health clinical knowledge and ability to review and/or… more
    Centene Corporation (09/19/24)
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  • Utilization Review Social Work Care…

    Hartford HealthCare (Torrington, CT)
    …* Master's degree in Social Work * Active LCSW required * Two years with behavioral health utilization review As a Hartford HealthCare entity, Charlotte ... of the Inpatient Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the IP… more
    Hartford HealthCare (08/08/24)
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  • RN - Utilization Review Case Manager

    LifePoint Health (Danville, VA)
    *Registered Nurse, RN - Utilization Review Case Manager* Job Type:Full Time|Days *$10,000 Sign-on Bonus Eligibility for Full-Time, Bedside RNs* ** Must have ... Utilization Review experience.** ** * ** *Your...Professional development and growth opportunities *Department/Unit Summary* Our Case Management Department primarily serves the adult population in our… more
    LifePoint Health (09/10/24)
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