- Elevance Health (MI)
- …and overseeing clinical/non-clinical activities. Will also be responsible for utilization review /management. May be responsible for developing and ... state or territory of the United States when conducting utilization review or an appeals consideration and...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …and substance use disorders. We are much more than just the third largest non-profit behavioral health system in the country, our 220-acre main campus, and our ... a state-of-the-art psychiatric urgent care center and a soon-to-be-built pediatric behavioral health center, outpatient, inpatient, partial hospitalization (day… more
- Highmark Health (Lansing, MI)
- …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
- CVS Health (Lansing, MI)
- …experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health /Substance Abuse or Maternity/ Obstetrics experience. ... At CVS Health , we're building a world of health ...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized… more
- Corewell Health (Dearborn, MI)
- …referral resources, bereavement support, adjustment counseling, facilitating guardianships and behavioral health concerns (including psychiatric transfers). + ... inpatients and Partial program patients and also may perform utilization review for this patient population +...and innovation in the fields of orthopedics, neurosciences, women's health , heart & vascular, and cancer care. QUALIFICATIONS: +… more
- Highmark Health (Lansing, MI)
- …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …and substance use disorders. We are much more than just the third largest non-profit behavioral health system in the country, our 220-acre main campus, and our ... a state-of-the-art psychiatric urgent care center and a soon-to-be-built pediatric behavioral health center, outpatient, inpatient, partial hospitalization (day… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …and substance use disorders. We are much more than just the third largest non-profit behavioral health system in the country, our 220-acre main campus, and our ... a state-of-the-art psychiatric urgent care center and a soon-to-be-built pediatric behavioral health center, outpatient, inpatient, partial hospitalization (day… more
- Highmark Health (Lansing, MI)
- …+ Participate in product specific Pharmacy and Therapeutics Committees and Drug Utilization Review (DUR) Committees as necessary or contractually required. + ... position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of...with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …and substance use disorders. We are much more than just the third largest non-profit behavioral health system in the country, our 220-acre main campus, and our ... a state-of-the-art psychiatric urgent care center and a soon-to-be-built pediatric behavioral health center, outpatient, inpatient, partial hospitalization (day… more