- Centene Corporation (Jefferson City, MO)
- … of services + Provides education to providers members and their families regrading BH utilization process + Interacts with BH healthcare providers as ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- G-TECH Services, Inc. (Detroit, MI)
- …field such as NICU/OB/ BH /Substance Abuse * * InterQual/MCG or other utilization review experience preferred Required Skills/Experience - The rest of the ... which may include acute patient care, discharge planning, case management, and utilization review with another insurance provider, etc. Demonstrates clinical… more
- VNS Health (Manhattan, NY)
- …of the community's needs. + Oversees the implementation and monitoring of utilization review and quality management procedures, while also conducting specialized ... within a behavioral health organization (BHO), with minimum of 4 years in a BH utilization and care management Director or above leadership role within a… more
- Molina Healthcare (Milwaukee, WI)
- …a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge ... of employment._** **_Ability/knowledge to cross train, inpatient medical to inpatient BH or inpatient Medical to PA is preferred._** **_Excellent computer skills… more
- Baystate Health (Springfield, MA)
- …strongly preferred + Requires a working knowledge of community resources and Utilization /Quality Review standards. + Understanding of the hospitals patient ... appropriate level of care and patient placement decisions. Manages and coordinates BH ED patient admission requests and Regional Transfer Center requests for correct… more
- HCA Healthcare (Richmond, VA)
- …nurse and/or delegates various tasks to staff RN's. Provides cross coverage for Utilization Review . + Maintains a competent staff through working with the ... us reach our goals. Unlock your potential! **Job Summary and Qualifications** The Nurse Manager is responsible for ensuring coordinated delivery of consumer care in… more
- Baystate Health (Springfield, MA)
- …meetings to address treatment objectives. **6.** May collaborate as assigned with utilization review specialist to obtain necessary insurance authorizations and ... is responsible for gathering a psychosocial evaluation through interviews and record review and completing a written assessment with case formulation and treatment… more
- Centene Corporation (Tallahassee, FL)
- …information from the Operations and Medical Management teams. Assesses and performs review of member clinical records and services related to behavioral health and ... staff, provider and member satisfaction + Serve as resource and liaison on utilization , quality improvement and case management activities + For NH Health Plan Only:… more