- Centene Corporation (Austin, TX)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and...health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review… more
- AmeriHealth Caritas (Washington, DC)
- …for further review . The reviewer independently applies medical and behavioral health guidelines to authorize services, ensuring they meet the patient's ... to efficiently document and assess patient cases + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …highly dedicated and motivated team of professionals, including medical and behavioral health care managers, dietitians, pharmacist, clinicians, medical ... Bring your true colors to blue. The RoleThe RN Utilization Management Reviewer is responsible for facilitating...at the right level of care to promote optimal health . This position is self-directed and works independently and… more
- HCA Healthcare (Dulles, VA)
- …Hospital Center! **Manages the day-to-day operations of the Behavioral Health Nursing Department through effective utilization of self, shift House ... your career path, we encourage you to apply for our Nurse Manager Behavioral Health opening. We review all applications. Qualified candidates will be… more
- CVS Health (Austin, TX)
- …not accepting applicants whose only acute care experience is in behavioral health ) **Preferred Qualifications** + 1+ years' experience Utilization Review ... At CVS Health , we're building a world of health...Job Description Primary Job Duties & Responsibilities Drives effective utilization management practices by ensuring appropriate and cost-effective allocation… more
- MVP Health Care (Rochester, NY)
- …For in New York** , and an **Inclusive Workplace** . The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental ... with at least 2 years being ASD related + Utilization or Case Management experience in a managed care...our customers in every interaction **Your key responsibilities:** + Review all requests for behavioral health… more
- Carle Health (Peoria, IL)
- …guidance to team members, and ensure compliance with IATP standards. LPHA reviewer provides behavioral health assessment, intervention, and consultation ... to individuals and/or groups identified as having behavioral health needs, plans treatment modalities, coordinates...provide crisis evaluation and intervention as needed. The LPHA Reviewer is recognized as a Licensed Practitioner of the… more
- Magellan Health Services (Baton Rouge, LA)
- …the job description. Other Job Requirements Responsibilities RN/BSN or clinical credentials in a behavioral health field. If not an RN, must hold Masters or ... + Provides training, interpretation and support for QI Clinical Reviewer staff. + Audits and validates internal audit results...Doctoral Degree and be a licensed behavioral health professional. Good organization, time management… more
- Elevance Health (Houston, TX)
- …limited to: + Partners with internal UR staff and external Behavioral Health Providers to ensure appropriate and consistent utilization of plan benefits, out ... of psychological testing and neuropsychological testing services. + Partners with Behavioral Health Management staff by assisting in training, attending… more
- Centene Corporation (Baton Rouge, LA)
- …team and make a meaningful impact on the lives of individuals receiving outpatient behavioral health care in Louisiana. + The ideal candidate will: + Hold ... active Louisiana Psychologist license + Be passionate about delivering high-quality, evidence-based behavioral health care + Support Louisiana to ensure clinical… more