- Molina Healthcare (NM)
- …Business Hours .** JOB DESCRIPTION Job Summary Provides support for member clinical service review processes specific to behavioral health. Responsible for verifying ... that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations, and ensuring members reach desired… more
- UCLA Health (Los Angeles, CA)
- …The Public Mental Health Partnership (PMHP) is seeking to hire a full time Clinical Quality Analyst (CQA) to conduct fidelity reviews for ACT/FACT ... part of its work as a California Center of Excellence (COE) under the BH -CONNECT Initiative. The CQA will conduct fidelity reviews on-site (in person) at team sites… more
- Commonwealth Care Alliance (Boston, MA)
- …Provider Contracting department and will have regular interaction with relevant internal Clinical , Quality , and BI departments, while frequently interfacing with ... for Mental Illness (FUH) data:** + Work with BI, Quality , and BH teams to evaluate and...Network on the measures** + Organize trainings, working with Quality and Clinical teams to build reference… more
- SSM Health (MO)
- …Type:** Regular **Job Highlights:** Exciting Opportunity for an Epic Systems Analyst at SSM Health! Required certifications are EpicCare Ambulatory, Inpatient ... Clinical Documentation, or Procedure Orders. Preferred certifications are Beacon...reports for multiple Epic applications. Tests build to ensure quality delivery to business partners. + Implements and stabilizes… more
- Centene Corporation (Madison, WI)
- …clinicians and ensures compliance with applicable guidelines + Monitors and tracks UM BH resources to ensure adherence to performance, quality , and efficiency ... preferred. Understanding of medical necessity criteria for a broad range of BH services preferred. **License/Certification:** + LCSW- License Clinical Social… more
- Centene Corporation (Richmond, VA)
- …level of care and services are medically appropriate related to behavioral health ( BH ) and/or autism spectrum disorder needs and clinical standards + Performs ... changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene...accordance with ABA regulatory guidelines and criteria + Analyzes BH member data to improve quality and… more
- Elevance Health (Charleston, WV)
- …you will make an impact:** + Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary ... quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as appropriate.… more
- Elevance Health (FL)
- …you will make an impact:** + Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary ... quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as appropriate.… more