- Centene Corporation (New York, NY)
- …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
- Excellus BlueCross BlueShield (Rochester, NY)
- …Summary: This position is responsible for coordinating, integrating, and monitoring the utilization of behavioral health (BH) services for members, ... requested for the diagnosis and treatment of members' behavioral health conditions, applying established clinical review criteria, guidelines and medical… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Molina Healthcare (Buffalo, NY)
- …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
- Elevance Health (Latham, NY)
- …Care Manager II** is responsible for managing autism services and behavioral health treatment benefits through written review . **How you will make an ... the Elevance Health family of companies, **Carelon Behavioral Health ** , offers superior clinical mental...requirement for this position. + Previous experience in case management/ utilization management with a broad range of experience with… more
- MVP Health Care (Tarrytown, NY)
- …being the difference for our customers in every interaction **Your key responsibilities:** + Review all requests for behavioral health services utilizing the ... improvement. To achieve this, we're looking for a **Professional, Behavioral Health ** to join #TeamMVP. If you...with at least 2 years being ASD related + Utilization or Case Management experience in a managed care… more
- Humana (Albany, NY)
- …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
- Elevance Health (Middletown, NY)
- ** Behavioral Health Care Manager II** **Shift:** Friday - Monday; 8:00am - 7:00pm EST - Schedule may flex based on business needs **Location:** Virtual; within ... for employment, unless an accommodation is granted as required by law._ The ** Behavioral Health Care Manager II** is responsible for managing psychiatric and… more
- MVP Health Care (Rochester, NY)
- …and continuous improvement. To achieve this, we're looking for a **Medical Director, Behavioral Health Children's Services** , to join #TeamMVP. If you have ... of NYS child serving systems. + Experience with critical review in clinical scenarios is desirable. + Knowledge of...MVP's efforts to collaborate in person and virtually with behavioral health network providers and facilities around… more
- Garnet Health (Harris, NY)
- …for the detox patient on the medical floor assuring discharge planning, utilization review , and insurance approval. Join the Garnet Health team and let your ... your career home with us as a Social Worker on our Inpatient Behavioral Health Unit (BHU) team at/in Garnet Health Medical Center-Catskill. Responsibilities… more
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