- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …years of clinical experience in Behavioral Health Care settings + Utilization Management experience preferred + CCM or other applicable certification(s) ... your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care...and BCBSMA policies and procedures + Focus on efficient utilization management with emphasis on discharge planning… more
- AmeriHealth Caritas (Charleston, SC)
- …**Responsibilities:** Under the direction of the Supervisor, the Behavioral Health Utilization Management Reviewer is responsible for completing medical ... all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer...behavioral health and substance use disorder experience.; + Utilization management experience in a managed care… more
- AmeriHealth Caritas (Robbinsville, NJ)
- …clinical department's daily functions, including triage of calls, care coordination, and utilization management .; The Behavioral Health Care Manager ... need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- CVS Health (Frankfort, KY)
- …state agency/stakeholder meetings when requested * Oversight and implementation of the utilization management program for behavioral health services, ... the health plan. They will have key roles in utilization management and case management ...entities * Overseeing the complaint and grievance process for behavioral health denials, * Review and resolution… more
- CVS Health (Baton Rouge, LA)
- …other agency/stakeholder meetings when requested. * Oversight and implementation of the utilization management program for behavioral health services, ... over/under- utilization . * Ensuring consistency in the application of utilization management standards, including those implemented by subcontracted entities… more
- CVS Health (Tallahassee, FL)
- …reside in state of Florida, position is 100% remote._** Behavior Analysis Utilization Management Clinical Consultant applies critical thinking and is ... the Florida Medicaid Health system strongly preferred + Managed care experience + Utilization review experience + Claims review experience strongly preferred… more
- Molina Healthcare (Columbus, OH)
- …of experience in case management , disease management or utilization management in managed care, medical or behavioral health settings. + Two years of ... will require auditing charts of OH Health Plan care review clinicians (UM) and providing feedback and corrections to...auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management … more
- BronxCare Health System (Bronx, NY)
- Overview The Coordinator- Behavioral Health Utilization Management (BH-UMC) will review and monitor all patientsadmitted into psychiatry or substance ... according to nationally recognizedcriteria. Responsibilities The Coordinator- Behavioral Health Utilization Management (BH-UMC) will review and monitor… more
- Point32Health (MA)
- …. **Job Summary** In this part-time role, the Behavioral Health Psychologist Reviewer will primarily perform utilization management and provider payment ... of Behavioral Health Lead Medical Director for Utilization Management (UM) and/or the Medical Director...**Key** **Responsibilities/Duties** **- what you will be doing** + ** Utilization Management ** + Performs clinical review… more
- VNS Health (Manhattan, NY)
- …and implementation of the behavioral health sections of the Quality Management (QM)/ Utilization Management (UM) Plan. Oversees the administration of ... implements, monitors and evaluates Utilization and Care Management metrics specific to Behavioral health services...community's needs. + Oversees the implementation and monitoring of utilization review and quality management … more