- Centene Corporation (Tallahassee, FL)
- …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
- Centene Corporation (Tallahassee, FL)
- …experience in applied behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / ... health clinicians preferred. Behavioral health clinical knowledge and ability to review ...Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with… more
- Monte Nido (Miami, FL)
- …lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - EST or CST hours** ... strategies to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting daily administrative… more
- Humana (Tallahassee, FL)
- …care management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and ... part of our caring community and help us put health first** The Behavioral Health ...insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management review… more
- CenterWell (Tallahassee, FL)
- …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 (Tallahassee, FL)
- …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
- Molina Healthcare (FL)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization management… more
- Molina Healthcare (FL)
- …facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need ... disorders. * Approves prior authorization requests for BHT treatment by reviewing Behavioral Health Therapy (BHT) assessments and treatment plans for medical… more
- Molina Healthcare (St. Petersburg, FL)
- …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
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- Summary Miami VA Healthcare System's Mental Health / Behavioral Science Service is seeking an experienced and dynamic Physician (Mental Health ) - Associate ... standards, while improving the Veteran's experience and outcomes. Defines mental health policies, utilization management process and procedures, financial and… more