- Fairfax County Sheriff's Office (Fairfax, VA)
- …(UR) Specialist has well-developed knowledge and skills in areas of utilization management (UM), behavioral health , medical necessity and overall patient ... autonomously as a licensed registered nurse performing an array of utilization management duties related to all Community Mental Health Rehabilitative… more
- CVS Health (Richmond, VA)
- …of care, and appropriate discharge planning + Serve as the behavioral health subject matter expert to support care management staff in serving Aetna ... foster collaboration and provide education and training + Consults with Plan executive management regarding physical and behavioral health clinical issues as… more
- Humana (Richmond, VA)
- …value-based care, quality metrics, population health , and disease or care management . The Behavioral Health Medical Director may develop procedures, ... part of our caring community and help us put health first** The Behavioral Health ...management , utilization management , case management , discharge planning and/or home health or… more
- CVS Health (Richmond, VA)
- …positive outcomes and enhance overall well-being. What you will do + Coordinates behavioral health assessments to gain information on substance abuse history and ... measurable outcomes. + Configures electronic medical software to categorize behavioral health conditions by severity. + Edits...to deliver an impactful message surrounding client rights and health needs. + Examines the data management … more
- Bon Secours Mercy Health (Portsmouth, VA)
- …with PRN Hours Days/Nights **Summary of Primary Function/General Purpose of Position** The Behavioral Health Registered Nurse (RN) functions as a care provider ... Collects and records nursing assessment of the physical and behavioral health status of the patient. *...patient outcomes are met. * Participates in the safe management of the milieu, intervening effectively with patients who… more
- CVS Health (Richmond, VA)
- …treatment resources, mental health managed care programs, and Aetna Behavioral Health policies and procedures, and criteria.- Interact with Supervisors ... clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning,… more
- Elevance Health (Richmond, VA)
- …responsible for appeals reviews within our Medicaid and Medicare programs.** The ** Behavioral Health Medical Director** is responsible for the administration of ... behavioral health medical services, to ensure the...clinical reviews. + The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and… more
- HCA Healthcare (Hopewell, VA)
- **Description** Introduction Do you have the career opportunities as a Behavioral Health Counselor you want with your current employer? We have an exciting ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free...appropriate next level of care.7. Has working knowledge of utilization management and case management … more
- Veterans Affairs, Veterans Health Administration (Chesapeake County, VA)
- …Care Network (VISN 6), Hampton (HVAMC).This position is aligned under the Behavioral Health Interdisciplinary Program (BHIP)/Outpatient Services and will serve ... Summary This position is located within the Veterans Health Administration (VHA), VA Mid-Atlantic Health ...to patients; patient satisfaction activities; patient safety and risk management activities; and utilization management .… more
- CVS Health (Richmond, VA)
- …health services. Coordinate with health plan staff (eg Member Services, Utilization Management , Care Management , Provider Network) to secure needed ... services for individual members In conjunction with health plan staff (eg Utilization Management...staff (eg Utilization Management , Care Management ) coordinate processes related to behavioral and… more
- CVS Health (Richmond, VA)
- …affordable. This is a full time remote teleworker position in Virginia supporting the behavioral health team. Travel is required; 25-40% of the time in Virginia. ... Bring your heart to CVS Health . Every one of us at CVS ...to coordinate, document and communicate all aspects of the utilization /benefit management program.-Applies critical thinking and knowledge… more
- Highmark Health (Richmond, VA)
- …account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and case/ disease management ... information to improve individual outcomes as an adjunct to health coaching. If acting in the capacity as a...review. + Assist in the development and implementation of utilization management programs including but not limited… more
- CVS Health (Richmond, VA)
- …Utilizes skills to coordinate, document and communicate all aspects of the utilization /benefit management program. -Applies critical thinking and knowledge in ... Bring your heart to CVS Health . Every one of us at CVS ...and education for members through the use of care management tools and resources. Evaluation of Members; Through the… more
- CVS Health (Richmond, VA)
- …organization-wide business functions including claims, member services, compliance, quality, utilization management , and network/provider services. + Serve as ... Bring your heart to CVS Health . Every one of us at CVS ...5+ years of clinical practice experience in physical or behavioral healthcare. + 5+ years of management … more
- Highmark Health (Richmond, VA)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- The Arora Group (Fort Belvoir, VA)
- …including crisis counseling to individuals, groups and families as needed to facilitate behavioral health clinical care management and optimize care. + ... in clinical and non- clinical settings. This support shall include provision of behavioral health services, screening, evaluation, management and referrals… more
- Highmark Health (Richmond, VA)
- …Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services, ... utilization , identification of opportunities for referral to a Health Coach/case management , and identification and resolution...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Elevance Health (Richmond, VA)
- …care plans by educating members regarding clinical needs and facilitating referrals to health professionals for behavioral health needs. + Uses motivational ... Management II** **$2000 Sign on Bonus** At **Federal Health Products and Services - FHPS** , a proud...for multiple managed conditions to ensure cost-effective and efficient utilization of health services. Conducts assessment, planning,… more
- Highmark Health (Richmond, VA)
- …:** **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
- Elevance Health (Arlington, VA)
- …identification, evaluation, coordination and management of member's needs, including physical health , behavioral health , social services and long term ... chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. + Obtains a thorough and accurate… more