- Centene Corporation (Raleigh, NC)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... WORK 10 HOURS.** **THIS ROLE WILL MAINLY SUPPORT MEDICARE BEHAVIORAL HEALTH ALL STATES AND DELAWARE MEDICAID...health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review… more
- Elevance Health (Durham, NC)
- …Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May be ... 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
- Veterans Affairs, Veterans Health Administration (Fayetteville, NC)
- Summary The Inpatient Behavioral Clinic is looking for Behavioral Health (RN) to join our Team. RN will directly reports to the Nurse Manager or designee of ... the Inpatient Behavioral Health Unit. He/She demonstrates competency in...a risk to staff and Veterans. Demonstrates competency in utilization of Prevention and Management of Disruptive Behavior (PMDB).… more
- Granville Health System (Oxford, NC)
- …Care case management tasks in the ED as well as within GHS. Behavioral Health responsibilities in this role may include: completing Psychosocial Assessments; ... one level of care to another using available resources. Job Functions 1. Provides behavioral health assessment, in partnership with the ED physician, to patients… more
- Elevance Health (Winston Salem, NC)
- ** Behavioral Health Care Manager I (3rd Shift -After Hours)** This role enables associates to work virtually full-time, with the exception of required in-person ... on holidays as part of a rotating schedule._ The ** Behavioral Health Care Manager I (3rd Shift...or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review .… more
- Granville Medical Center (Oxford, NC)
- …Care case management tasks in the ED as well as within GHS. Behavioral Health responsibilities in this role may include: completing Psychosocial Assessments; ... one level of care to another using available resources. Job Functions 1. Provides behavioral health assessment, in partnership with the ED physician, to patients… more
- CenterWell (Raleigh, NC)
- …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 (Raleigh, NC)
- …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
- Elevance Health (Durham, NC)
- …Services. + Partners with internal UR staff and external Behavioral Health Providers to ensure appropriate and consistent utilization of plan benefits, ... services, and clinical guidelines within scope of license. + Conducts pre-certification, concurrent review , and appeals of Behavioral Health OP services. +… more
- Elevance Health (NC)
- …access to the same basic benefits and services, including Physical health , Behavioral health , Pharmacy,_ _Intellectual/Developmental_ _Disabilities (I/DD) ... to the CFSP Care Management model which includes physical health , behavioral health , and social...include, but are not limited to: + Manages resource utilization to ensure appropriate delivery of care to members,… more