- AmeriHealth Caritas (Philadelphia, PA)
- …managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover ... Review Home Modification Team and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing technical and… more
- Highmark Health (Pittsburgh, PA)
- …with operational areas regarding issues related to supported technology. Manage utilization review , translation of foreign claims, coordination of benefits ... **Company :** Allegheny Health Network **Job Description :** REPOSTED: 20251114 REPOSTED: 20251112 Date Posted: 20250411 Location: Allegheny General Hospital… more
- UPMC (Pittsburgh, PA)
- …that include the medical, behavioral , pharmacy, and social needs of the member. Review UPMC Health Plan data for services the member has received and ... and modifies the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system… more
- Veterans Affairs, Veterans Health Administration (Redding, CA)
- …workforce of approximately 8 employees. The COM helps to ensure that the Behavioral Health Interdisciplinary Program BHIP Team meets the overall performance ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- Northern Light Health (Unity, ME)
- …In improving the care of the patient and families of Northern Light Health physician practices, the physician practice manager is committed to the constant pursuit ... Quality Assurance, AOA and other governmental agencies. + Performs periodic review of established processes to assure staff understanding to identify opportunities… more
- Highmark Health (Carson City, NV)
- …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
- WellSpan Health (York, PA)
- …providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. ... management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education relative to … more
- WellSpan Health (Chambersburg, PA)
- …providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. ... management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education relative to … more
- Carle Health (Normal, IL)
- …knowledge of behavioral managed care and the precertification and utilization review activities necessary to obtain treatment approval. + Participates ... to learn and level of comprehension. + Consults appropriate resources within Behavioral Health Division to provide specialized education. + Demonstrates… more
- UnityPoint Health (Cedar Rapids, IA)
- …assistance in assessment, planning, implementation and evaluation of patient care on the behavioral health units under the direction of a registered nurse. ... in need of the secure setting of a locked behavioral health unit. St. Luke's CARE delivery...Is knowledgeable regarding managed care implications - precertifications and utilization review + Maintains competence in performing… more