- Molina Healthcare (Los Angeles, CA)
- …for requested treatments and/or procedures. * Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. * Processes ... years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education… more
- Molina Healthcare (Detroit, MI)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes requests ... within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. + Requests additional information from members or providers in consistent and efficient manner. + Makes appropriate referrals to… more
- Highmark Health (Pittsburgh, PA)
- …Preferred + Older Adults Protective Services Act (OAPSA) clearance + Prior counseling experience in a behavioral health setting **_Disclaimer:_** _The job ... description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications… more
- CVS Health (Sacramento, CA)
- …+ Direct clinical experience in a hospital setting or prior Utilization Management experience. + Valid California unrestricted independent professional ... behavioral health clinical license **Education** + If RN, Bachelor's degree in nursing required with 3 years of behavioral health experience + If BH-licensed, Masters degree in Social Work, Counseling, Psychology required **Anticipated Weekly Hours** 40 **Time… more
- Centene Corporation (Columbia, SC)
- …to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to determine ... medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning + Analyzes BH member data to improve… more
- Centene Corporation (Phoenix, AZ)
- …(BH) and/or autism spectrum disorder needs and clinical standards + Performs prior authorization reviews related to BH to determine medical appropriateness in ... accordance with ABA regulatory guidelines and criteria + Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members… more
- Molina Healthcare (Las Vegas, NV)
- …with autism spectrum disorder (ASD) and other related disorders. * Approves prior authorization requests for BHT treatment by reviewing BHT assessments and treatment ... plans for medical necessity and BHT best practice guidelines. This includes but is not limited to: psychological evaluation requests, comprehensive diagnostic evaluations (CDEs), functional behavioral assessments (FBAs), and progress reports. * Participates in… more
- University of Utah Health (Salt Lake City, UT)
- …is a participating employer with Utah Retirement Systems ("URS"). Eligible new hires with prior URS service, may elect to enroll in URS if they make the election ... before they become eligible for retirement (usually the first day of work). Contact Hospitals and Clinics Human Resources at ### for information. Individuals who previously retired and are receiving monthly retirement benefits from URS are subject to URS'… more
- Trinity Health (Livonia, MI)
- …and family needs Assures that an effective transition plan is in place prior to discharge. 8. Assists in the development of educational materials and protocols. ... specifically related to the care of the cardiac patient. Assists in research protocols and advises research staff of potential candidates Acts as a resource to the multi-disciplinary teams. May utilize workshops and/or seminars to increase professional… more
- Eastern Connecticut Health Network (Manchester, CT)
- …certification within 6 months of hire into the role. EXPERIENCE: + Prior experience working in the Behavioral Health field, preferably to specific prospective ... service setting. + Level of care age-specific competencies is required. COMPETENCIES: + Working knowledge of psychiatric disorders, familiarity with abuse and neglect reporting mandates, knowledge of community-based resources and comprehension of the… more