- Humana (Charleston, WV)
- …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… more
- Humana (Charleston, WV)
- …such as provider relations, claims submission and payment, utilization management processes, behavioral health processes, and dispute resolution. ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Senior...educational material, or trainings. + 3+ years of project management experience with mid-size projects. + 2+ years of… more
- Highmark Health (Charleston, WV)
- …Time - Weekends Required.** This job implements the 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...years of post licensure experience in a combination of Behavioral Health Clinical, Case Management … more
- CVS Health (Charleston, WV)
- …outreaches and computer documentation. + Assist members with locating community based behavioral health resources. **Required Qualifications** + 3+ years of ... direct clinical practice experience + An active and unrestricted clinical behavioral health license in state of residence is required (ex: LPC, LCSW, LMFT, LPCC,… more
- Highmark Health (Charleston, WV)
- …leading and managing pharmacy teams + 5 years of experience leading a health -related (preferably utilization , medication management ) function within a ... a specific segment of the Organization's members and/or specific health management products and services. Ensures attainment...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Charleston, WV)
- …of the department's case management processes. This may include utilization management , strategic planning, care cost initiatives, system development and ... corporation to resolve issues and ensure activities coincide with Case Management processes. **ESSENTIAL RESPONSIBILITIES** + Manage and coordinate all department… more
- Highmark Health (Charleston, WV)
- …in addition to 3 weekdays** 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
- Highmark Health (Charleston, WV)
- …:** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent assesses ... coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- BrightSpring Health Services (Dunbar, WV)
- …Community Living, Adult Host Homes for adults regardless of disability, Behavioral /Mental Health Support, In-home Pharmacy Solutions, Telecare and Remote ... ResCare Community Living Overview This position plans, directs, and coordinates health services for all assigned service sites. Provides oversight and direction… more
- Elevance Health (Charleston, WV)
- …A proud member of the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health Options, offers superior clinical mental ... preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For… more
- Highmark Health (Charleston, WV)
- …:** **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
- Humana (Charleston, WV)
- …and subpopulations. Areas of focus include Care Management , Quality Improvement, Utilization Management , Population Health , Social Determinants of ... Health , Pharmacy, Behavioral Health , and Long-Term Services and Supports. Key responsibilities include: + Lead the development of actionable go-to-market… more
- Veterans Affairs, Veterans Health Administration (Martinsburg, WV)
- …Education. Hold a bachelor's degree in drug and alcohol studies or a related behavioral health field from an accredited college or university. In some ... National Certified Addiction Counselor Level 1. Loss of License. Management officials, in collaboration with Human Resource (HR) Office...in a drug and alcohol studies or a related behavioral health field with an exemplary academic… more
- Highmark Health (Charleston, WV)
- …, physician practice management or clinical operations, ancillary provider management or clinical operations, and/or health insurance) with significant ... knowledge of and experience with various care delivery models + Experience in health plan provider network performance management , care/case management ,… more
- CVS Health (Lewisburg, WV)
- …(WV) license + 5+ years' clinical practice experience + 1+ years of behavioral health experience + 2+ years' experience with personal computer, keyboard, ... Bring your heart to CVS Health . Every one of us at CVS ...to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs… more
- Highmark Health (Charleston, WV)
- …**SKILLS** + Driving technology sales + Background on IT + Background in Care Management , Utilization Management , and Digital Products and Services + ... channel growth for enGen. Work closely with marketing, sales engineering and product management to deliver on targets, objectives and provide a voice of the partner.… more
- Highmark Health (Charleston, WV)
- …to deliver financial results to the Enterprise. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved in ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the… more
- Veterans Affairs, Veterans Health Administration (Martinsburg, WV)
- …Education. Hold a bachelor's degree in drug and alcohol studies or a related behavioral health field from an accredited college or university. In some ... vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). Participation in the Coronavirus Disease 2019 (COVID-19)… more
- Highmark Health (Charleston, WV)
- …resource efficiency. + Proposes ideas, designs, and solutions to lead engineers and management to further cloud service utilization and optimization. + Develops ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job...of action. + Level 3 Incident, problem and change management as it pertains to the responsibilities of the… more
- Highmark Health (Charleston, WV)
- …sales revenue and expanding market share through new client acquisition and relationship management . The ideal candidate will have a strong background in B2B sales, ... as: Financial Services, Utilities, Property and Casualty Insurance + CRM utilization **Preferred** + Transactional print and mail and digital delivery experience… more