- Highmark Health (Pittsburgh, PA)
- …in planning/marketing strategy to ensure referral sources. + Participates in peer utilization and/or review and assists in coordination of related quality ... **Company :** Allegheny Health Network **Job Description :** GENERAL OVERVIEW: Provides...with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas of BCBSMA. ... anticipatory case management for members whose cases come for review , in partnership with case managers + Participate in...order to participate in panel appeals + Experience in Utilization Management in a managed-care environment (as a clinician… more
- Healthfirst (NY)
- …out of home placement, and//or community-based services and may be called upon to do Utilization Review for those services + Develops care plans that align with ... advocating, informing, and educating beneficiaries on services, self-management techniques, and health benefits related to the continuum of care + Reviews discharge… more
- Molina Healthcare (Louisville, KY)
- …speed required. JOB DESCRIPTION Job Summary Provides support for member clinical service review processes specific to behavioral health . Responsible for ... KY or have a compact RN license. The Care Review Clinician Inpatient Review BH will provide...for outpatient and inpatient services for the OH Medicaid behavioral health population. Strong post-acute level of… more
- Ventura County (Ventura, CA)
- …24 primary care clinics, 11 specialty care clinics, Ambulatory Care, the Public Health Department, the Behavioral Health Department, and the Ventura ... and communicates matters of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization...care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review … more
- Molina Healthcare (NM)
- …degree in a healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN (preferred) or LPN...good standing, such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians… more
- CVS Health (Baton Rouge, LA)
- …acknowledges physicians for their clinical excellence and effective utilization of health care resources. Reporting to the Executive Behavioral Health ... guidelines and clinical criteria, drawing on comprehensive knowledge of health care delivery systems, utilization methodologies, reimbursement models, and… more
- BrightSpring Health Services (Columbia, MO)
- Our Company SpringHealth Behavioral Health and Integrated Care Overview Provide direct oversight and supervision to BCBA's, BCaBA's, RBT's and Behavior ... program development + Meet with school districts to provide current information on Spring Health Behavioral Health and Integrated Care Services + Explore… more
- Commonwealth Care Alliance (Boston, MA)
- 011230 CA-Provider Engagement & Performance Position Summary: The Behavioral Health (BH) Provider Engagement Program Manager is responsible for cultivating ... strong, collaborative relationships with behavioral health providers and driving performance improvement...teams to support consistency and quality across BH and Health Home providers. * Participate in case review… more
- BrightSpring Health Services (Anaheim, CA)
- Our Company SpringHealth Behavioral Health and Integrated Care Overview If you're a BCBA in the state of California, and are looking for a leadership role, WE ... client + Conduct weekly meetings with each BCBA: + Review billable hours spreadsheets and discuss productivity + ...with school districts to provide current information on Spring Health Behavioral Health and Integrated… more