- AmeriHealth Caritas (LA)
- **Role Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing ... all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer...in Social Work + Minimum of 2 years of behavioral health experience and substance use disorder… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …a member's benefit coverage while working remotely. Primary Responsibilities * Performs behavioral health clinical utilization reviews using evidenced based ... pace and changing environment- flexibility in assignment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical… more
- PeaceHealth (Bellingham, WA)
- **Description** PeaceHealth is seeking a RN Admissions/ Utilization Behavioral Health - Care Management for a Full Time, 1.00 FTE, Day position. The salary ... status and notify payer. + Provide admission support to Behavioral Health unit/ED/SECU as needed. Assist MSW...diagnostics. + Preferred: Third party reimbursement knowledge. + Preferred: Utilization Review experience, someone who can talk… more
- Molina Healthcare (Bowling Green, KY)
- …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
- CVS Health (Oklahoma City, OK)
- …to identify and address patient needs (eg care team, social work, behavioral health , utilization management, Hard-to-Reach, Central Telehealth, etc.). ... follow-up care, and next steps. + Coordinate with the Utilization Management team to review medical and...we looking for?** **Required Qualifications** + Active RN or Behavioral Health (BH) license in good standing… more
- UNC Health Care (Hendersonville, NC)
- …for behavioral health services. Working closely with behavioral health clinicians, utilization review , case management, and finance teams, the ... This role involves the review , coordination, and tracking of behavioral health referrals, ensures adherence to safety protocols, age-appropriate clinical… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …with the ability to manage multiple priorities and work independently. Experience in Behavioral Health and Utilization Management is preferred, and ... manage multiple priorities and work independently. * Experience with Behavioral Health and Utilization Management...discover more about what we have to offer, please review our benefits page. Role Designation Hybrid Anchored in… more
- Spectrum Billing Solutions (Skokie, IL)
- …(Word, Excel, billing software). + Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization ... Utilization Management Specialist | ABA UR Specialist | Behavioral Health Billing Specialist #UtilizationReviewSpecialist | #UtilizationManagementSpecialist… more
- Health Care Service Corporation (Albuquerque, NM)
- …**Job Summary** This position is responsible for ensuring accurate and timely clinical review of behavioral health cases (Applied Behavior Analysis (ABA)) ... reviewing medical records, reviewing cases which involves contract interpretation of behavioral health diagnoses, and utilizing knowledge of medical necessity… more
- CVS Health (Harrisburg, PA)
- …clinically appropriate treatment, evidence based care an clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. - ... One of the following is required: Unencumbered Master's Level Behavioral Health clinical license in the state...required for either BH or RN -1+ years of utilization review / utilization management required (ie… more