- Molina Healthcare (AZ)
- …Hours .** JOB DESCRIPTION Job Summary Provides support for member clinical service review processes specific to behavioral health . Responsible for verifying ... May work collaboratively with appropriate departments to provide applied behavior analysis (ABA)/ behavioral health therapy (BHT) services to Molina members with… more
- Molina Healthcare (AZ)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- Molina Healthcare (Phoenix, AZ)
- …management, care review , utilization management, transitions of care, behavioral health , long-term services and supports (LTSS), and/or other program ... within Molina's clinical/healthcare services function, which may include care review , care management, and/or correspondence processing, etc. * Researches and… more
- Adelante (Goodyear, AZ)
- … health issues and provider's education to assist with enhancing primary care utilization of behavioral health interventions + Promote a smooth interface ... will be responsible for completing initial intakes for the behavioral health program. The therapist will make...recommendations for a portion of these patients by record review without seeing the patients. The therapist will contact… more
- Adelante (Phoenix, AZ)
- … health issues and providers education to assist with enhancing primary care utilization of behavioral health interventions + Promotes a smooth interface ... will be responsible to complete initial intakes for the behavioral health program. The therapist will make...recommendations for a portion of these patients by record review without actually seeing the patients. The therapist will… more
- Highmark Health (Phoenix, AZ)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... oversight over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member… more
- Highmark Health (Phoenix, AZ)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Highmark Health (Phoenix, AZ)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... units that may assist in the resolution of issues or problems. + Access, review , utilize, contribute content to and participate in the maintenance of the shared… more
- Highmark Health (Phoenix, AZ)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- Banner Health (Sun City West, AZ)
- …in cardiac services, women's health and maternity, robotic surgery and orthopedics, behavioral health , and critical care to name just few. In addition, we ... for coverage under the company's auto insurance policy. Employees working at Banner Behavioral Health Hospital must possess an Arizona Fingerprint Clearance Card… more