- LifePoint Health (Hickory, NC)
- …execution, adaptation and outcome of care management as prescribed in the initial Utilization Review Plan with regard to resources, appropriateness of care and ... Commission, OSHA, CMS, HCFA, AHCA). * Mentors staff on Utilization Review (UR) standards and Length of...to /making communities healthier/(R) with acute care, rehabilitation, and behavioral health facilities from coast to coast.… 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
- Highmark Health (Raleigh, NC)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job works collaboratively riskacross Highmark Health clinical areas to support clinical ... Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, state, CMS,… more
- Elevance Health (Winston Salem, NC)
- …work East Coast time zone hours.** The **Medical Director** will be responsible for utilization review case management for Commercial business in the New England ... 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
- City of Durham (Durham, NC)
- …Response Teams)-to meet the needs of people in crisis with compassionate care and behavioral health expertise. In the first twelve months of operation, and ... clinicians into Durham's 911 call center to triage, assess, and respond remotely to behavioral health related calls that can be resolved over the phone. It… more
- Highmark Health (Raleigh, NC)
- …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
- HCA Healthcare (Asheville, NC)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality… more
- HCA Healthcare (Asheville, NC)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with...growth, we encourage you to apply for our Mental Health Professional III License opening. We promptly review… more
- HCA Healthcare (Asheville, NC)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... an organization that invests in you as a Mental Health Professional III License? At Mission Hospital, you come...in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with… more