- Highmark Health (Harrisburg, PA)
- …effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource ... utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and… more
- UPMC (Pittsburgh, PA)
- … plan policy and procedures for inpatient, outpatient, Durable Medical Equipment (DME), Behavioral Health , and Private Duty Nursing. + Participate in health ... UPMC Health Plan is hiring a full-time UM...management certification or approved clinical certification preferred + Registered Nurse (RN) + Act 34 *Current licensure either in… more
- CVS Health (Phoenix, AZ)
- …be at the forefront of clinical decision-making, applying your expertise in Behavioral Health to ensure members receive appropriate, evidence-based care. You'll ... **Position Summary** We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team....Apply critical thinking and evidence-based clinical criteria specific to Behavioral Health to evaluate inpatient and outpatient… more
- AmeriHealth Caritas (LA)
- **Role Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical ... cases to integrated care management as needed. The BH UM Reviewer will apply medical health benefit...in Social Work + Minimum of 2 years of behavioral health experience and substance use disorder… more
- Corewell Health (Grand Rapids, MI)
- …patients through the continuum appropriately. Oversees the intake for the acute care behavioral health unit and ensure the completion of admission paperwork, ... mental agencies. Essential Functions + Oversees intake for the acute care behavioral health unit. Complete admissions paperwork, skin assessments, and physical… more
- CVS Health (Austin, TX)
- …and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): + ... is not accepting applicants whose only acute care experience is in behavioral health ) **Preferred Qualifications** + 1+ years' experience Utilization Review… more
- Highmark Health (Harrisburg, PA)
- …panel. Provides oversight over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of ... various resources to assist members in achieving their personal health goals. Will work with providers to insure quality...in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced training and… more
- Molina Healthcare (NM)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... Medicaid recipients. Preference will be given to those whose UM experience is within another MCO like Molina; experience...field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …improve provider performance and member satisfaction. Required Skills and Experience * Registered nurse or licensed behavioral health clinician (ie LICSW, ... Title: Care Manager PreService & Retrospective - Autism Location: Remote Career Area: Health Services About Blue Cross and Blue Shield of Minnesota At Blue Cross… more
- University of Southern California (Alhambra, CA)
- …10. Demonstrates collaborative working relationship with care team members, including pharmacy, behavioral health , field team, office staff, and facility staff. ... coordination services evaluating options and services required to meet an individual's health care needs to promote cost-effective, quality outcomes. Serves as a… more
- CVS Health (Baton Rouge, LA)
- …* Collaborate with care management and utilization management teams in monitoring behavioral health services, assure assessments for needed equipment are ... At CVS Health , we're building a world of health...and enrollees on prior authorization requests for services. The UM Coordinator will collaborate with all key stakeholders ensuring… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …those with varied clinical expertise (ex. Social Work, Behavioral Health , Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, ... health care services. Examples may include: Utilization Management, Quality, Behavioral Health , Pharmacy, Registered Dietitian and Respiratory Therapist +… more
- Tenet Healthcare (Detroit, MI)
- …: Minimum Qualifications BSN preferred. At least two (2) years acute hospital or Behavioral Health patient care experience required. One (1) year hospital acute ... healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the opportunity to make...or behavioral health case management experience preferred. Active… more
- San Antonio Behavioral Health (San Antonio, TX)
- …staff as needed. Essential Duties: + Collaborate and set standards with registered nurse (RN) case managers (CMs) and outcome managers to ensure that all ... indicated. + Identify and facilitate resolution of system process problems impeding UM functions. Identify and resolve delays and obstacles as appropriate. +… more
- Molina Healthcare (Sparks, NV)
- …experience in an intensive care unit (ICU) or emergency room. ASAM Certification for behavioral health Previous experience with MCG guidelines. At least 2 years ... teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least 2 years experience,… more
- Molina Healthcare (Akron, OH)
- …* Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Behavioral Health nursing experience- inpatient psychiatric, IMD, ... teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least 2 years experience,… more
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