- Health Care Service Corporation (Richardson, TX)
- …**Job Summary** This position is responsible for ensuring accurate and timely clinical review of behavioral health cases (Applied Behavior Analysis (ABA)) ... reviewing medical records, reviewing cases which involves contract interpretation of behavioral health diagnoses, and utilizing knowledge of medical necessity… more
- Centene Corporation (Austin, TX)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and...health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review… more
- CVS Health (Austin, TX)
- …not accepting applicants whose only acute care experience is in behavioral health ) **Preferred Qualifications** + 1+ years' experience Utilization Review ... At CVS Health , we're building a world of health...Job Description Primary Job Duties & Responsibilities Drives effective utilization management practices by ensuring appropriate and cost-effective allocation… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... problems to help patients access the full range of their benefits through the utilization review process. + Conducts admission reviews. + Conducts concurrent and… more
- Molina Healthcare (Austin, TX)
- …dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to ... -related regional medical necessity reviews and cross coverage. * Standardizes behavioral health -related utilization management, quality, and financial… more
- CVS Health (Austin, TX)
- …issues. * Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the ... care issues through established channels * Ability to speak to medical and behavioral health professionals to influence appropriate member care. * Utilizes… more
- Elevance Health (Houston, TX)
- ** Behavioral Health Medical** **Director-Psychiatrist** **Appeals** **Location:** This role enables associates to work virtually full-time, with the exception of ... The **Medical Director** is responsible for the administration of behavioral health medical services, to ensure the...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Immigration and Customs Enforcement (Houston, TX)
- … health provider peer reviews to include completion and dissemination of peer review reports to IHSC behavioral health unit administration for program ... Summary The Supervisory Behavioral Health Provider oversees clinical performance,...identified as having a serious mental illness using Mental Health Review form (IHSC-883). Works in conjunction… more
- CenterWell (Austin, TX)
- …best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can ... part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN...medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
- CenterWell (Austin, TX)
- …best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can ... part of our caring community and help us put health first** Healthcare isn't just about health ...medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more