- Excellus BlueCross BlueShield (Rochester, NY)
- …Summary: This position is responsible for coordinating, integrating, and monitoring the utilization of behavioral health (BH) services for members, ... of services requested for the diagnosis and treatment of members' behavioral health conditions, applying established clinical review criteria, guidelines… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health , Pharmacy, Registered ... Managers, especially those with varied clinical expertise (ex. Social Work, Behavioral Health , Respiratory Therapy, Registered Dietitian, Registered Nurse,… more
- Molina Healthcare (Buffalo, NY)
- …chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and ... and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Services Coordination Specialist provides administrative support for any of the programs of Utilization Management , Behavioral Health , Quality ... tasks under pressure. + Demonstrates proficiency in basic navigation and utilization of department specific applications: care management system, department… more
- Molina Healthcare (Bronx, NY)
- …Job Duties * Performs audits in utilization management , care management , member assessment, behavioral health , and/or other clinical teams, and ... Preferred Qualifications * Utilization management , care management , behavioral health and/or long-term services and supports (LTSS) clinical… more
- Centene Corporation (New York, NY)
- …in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of ... licensure as outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and ability to review… more
- CVS Health (Albany, NY)
- …working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal departments. + ... management program. + Conduct clinical reviews for adult inpatient behavioral health cases, applying established medical necessity criteria to ensure… more
- Helio Health Inc. (Syracuse, NY)
- …mission to treat and promote recovery from the effects of substance use, mental health disorders, and other behavioral healthcare issues. To support the mission ... staff on current principles and standards of practice surrounding utilization and denials management . + Use effective...Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care,… more
- CenterWell (Albany, NY)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous...and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral … more
- Elevance Health (Latham, NY)
- A proud member of the Elevance Health family of companies, **Carelon Behavioral Health ** , offers superior clinical mental health and substance use ... and insightful analytics to improve the delivery of care. ** Behavioral Health Care Manager II - ABA**...requirement for this position. + Previous experience in case management / utilization management with a broad… more