- Humana (Columbus, OH)
- …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 2 work… more
- Centene Corporation (Tallahassee, FL)
- …day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with ... a valid Florida clinical license. **Position Purpose:** Supervises the behavioral health (BH) utilization review ...performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …necessity criteria, interrater reliability test + Familiarity with our utilization management system, MedHOK What You Bring: + Behavioral Health professional ... your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care...experience in Behavioral Health Care settings + Utilization Management experience preferred + CCM or… more
- 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 (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
- Spectrum Billing Solutions (Skokie, IL)
- …Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist | UR Specialist | ... Review Specialist | ABA Utilization Review Specialist | ABA Utilization Management Specialist | ABA UR Specialist | Behavioral Health… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …us transform healthcare? Bring your true colors to blue. The RoleThe MSK Clinical Utilization Reviewer - LPN is responsible for reviews of commercial members ... work collaboratively with the MSK team and entire Clinical Utilization management team to facilitate orthopedic care...work: 8:30a - 4:30p EST. The TeamThe MSK Clinical Utilization Reviewer - LPN is part of… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for our Medicare ... our Hingham, MA office. Hours of work: 8:30a - 4:30p EST. The TeamThe Clinical Utilization Reviewer is part of a highly dedicated and motivated team of… more
- 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
- Kepro (Los Angeles, CA)
- …Reviewer to join our growing team in California. Job Summary As a Utilization Clinical Reviewer , you will leverage your expertise to meticulously assess ... will evaluate the medical necessity of psychiatric inpatient care to ensure appropriate utilization of services. This role is pivotal in maintaining the accuracy and… more
- CVS Health (Columbus, OH)
- …. + Independent BH Clinical License: LPCC, IMFT, or LISW + Managed care/ utilization review experience + Case management and discharge planning ... more personal, convenient and affordable. **Position Summary** The Care Plan Reviewer (Clinical Case Manager BH) utilizes advanced clinical judgment and critical… more
- Kepro (Indianapolis, IN)
- …Medical Director shall provide the clinical and administrative medical oversight for Behavioral Health Utilization Management reviews. The Medical Director ... the public sector. Acentra is looking for a Part-Time Behavioral Health Medical Director to join our growing team....Quality Assurance committee responsibility in a hospital setting. + Utilization Management (UM) review experience.… more
- Centene Corporation (Tallahassee, FL)
- … health utilization data, KPI review and monitoring of behavioral health utilization management metrics. Participates with development of corrective ... health related clinical training for associates and providers. + Works with utilization , case and disease management teams to implement and operationalize BH/PH… more
- 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
- Elevance Health (NC)
- … Behavioral Health OP services. + Mentors Behavioral Health Care Management staff by assisting in training, attending utilization management rounds, ... external Behavioral Health Providers to ensure appropriate and consistent utilization of plan benefits, out of network services, and clinical guidelines within… more
- US Tech Solutions (Columbus, OH)
- …FTE)** **Tentative Start Date-:** **12/22/2024** **Responsibility:** + The Care Plan Reviewer (Clinical Case Manager BH) utilizes advanced clinical judgment and ... thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider… more
- Magellan Health Services (Honolulu, HI)
- …Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community ... collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or… more
- Chenega Corporation (NM)
- …reporting, analysis, and makes recommendations for improvement. + Refers cases for review as appropriate to Program Integrity, Case Management , Care ... Services** ' company, is looking for a fully remote **Clinical Quality Reviewer ** to ensure compliance with the contract, and program requirements for Clinical… more
- 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
- 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