- Humana (Columbus, OH)
- …Influences and assists corporate leadership in strategic planning to improve effectiveness of behavioral health utilization management programs. + ... health first** Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management ( Behavioral Health ) who will utilize their clinical… more
- Humana (Columbus, OH)
- …community and help us put health first** Humana Healthy Horizons 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 (Columbus, OH)
- …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. + 2+ years of project management experience with mid-size projects. + 1+ years of… more
- CVS Health (Columbus, OH)
- …utilization /benefit management function Required Qualifications + Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered ... to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking...utilization review experience preferred + Experience in a behavioral health inpatient setting + Ability to… more
- CVS Health (Columbus, OH)
- …for Aetna. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management and ... This person will oversee and be responsible for all behavioral health activities in the health...be responsible for provider education regarding best clinical practices, utilization management , care management , claims… more
- CVS Health (Columbus, OH)
- …+ Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate ... established channels. + Ability to speak to medical and behavioral health professionals to influence appropriate member...clinical license preferred: LPCC, IMFT, or LISW + Managed care/ utilization review experience + Case management and… more
- Humana (Columbus, OH)
- …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
- AmeriHealth Caritas (Columbus, OH)
- …products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more ... ** Behavioral Health Medical Director (must reside...in the development of Medical Necessity Criteria and performs utilization management activities. Assures that organizational medical… more
- CVS Health (Columbus, OH)
- …The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral ... Physicians board-certified in Pediatrics or Adolescent Medicine with significant behavioral health or Addiction Medicine experience/specialization will be… more
- Molina Healthcare (Columbus, OH)
- …Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health ... and chemical dependency services and assists with implementing integrated Behavioral Health care management programs. **KNOWLEDGE/SKILLS/ABILITIES** +… more
- CVS Health (Columbus, OH)
- …including after-hours consultation as needed. * Leading all major clinical, population health management , and quality improvement components of the OhioRISE ... * Serving as the chair or co-chair of the Utilization Management committee and of the OhioRISE...* At least five years of experience with children's behavioral health services. * Must be a… more
- CVS Health (Columbus, OH)
- …for Aetna. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management and ... clinical coverage and policies. The Manager, Clinical Health Services is responsible for oversight and ...RN, LPPC, LPPC-S, LISW, LISW-S) . Master's degree in behavioral health field; or . Registered Nurse… more
- Highmark Health (Columbus, OH)
- …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
- CVS Health (Columbus, OH)
- …with the Behavioral Health , Pharmacy, member outreach, Care Management , National Quality Management , Utilization Management , Compliance, ... managed to improve health outcomes.* Leverage extensive knowledge of health care delivery system, utilization management , reimbursement methods… more
- Highmark Health (Columbus, OH)
- …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
- Highmark Health (Columbus, OH)
- …for the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review. Ensures all accurate information is ... including verification of benefit eligibility. Build cases in the utilization management system. + Use knowledge of...0 - 1 year of experience working in the Health Insurance Industry **LICENSES AND CERTIFICATIONS** **Required** + None… more
- Highmark Health (Columbus, OH)
- …:** **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
- BrightSpring Health Services (Columbus, OH)
- …Community Living, Adult Host Homes for adults regardless of disability, Behavioral /Mental Health Support, In-home Pharmacy Solutions, Telecare and Remote ... all CHANGES to LON based on submitted/approved IDRCs* Reviews Quickbase for utilization issues requiring IPC revisions in the waiver. Ensures needed revisions are… more
- Intermountain Health (Columbus, OH)
- …accredited institution. Degree will be verified. + Experience in case management , utilization review, or discharge planning. **Physical Requirements:** Ongoing ... works collaboratively with physicians and other members of the health care team to improve the health ...allocation of resources while balancing clinical quality and cost management . **Posting Specifics** + Pay Range: $39.99 - $59.18… more
- Highmark Health (Columbus, OH)
- **Company :** Highmark Health **Job Description :** Job Description **JOB SUMMARY** This role within the marketing & experience department will be at the forefront ... includes leveraging cutting-edge customer experience platforms, implementing robust data management solutions, and optimizing marketing automation tools to drive… more