- CVS Health (Columbus, OH)
- …+ Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse ( RN ) with unrestricted Ohio state license with psychiatric ... to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking... Health licensure (LISW, LMFT, LPCC) or if a Registered Nurse Associates degree required and BSN… more
- Community Health Systems (Gadsden, AL)
- …problem-solving skills for addressing unit challenges and emergencies. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The RN Charge oversees the operations of a nursing...Monitors patient flow, manages bed assignments, and optimizes resource utilization within the unit. + Conducts employee and patient… more
- Brighton Health Plan Solutions, LLC (NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests ... regulatory and accreditation requirements. * Duties as assigned. Essential Qualifications * Current Registered Nurse ( RN ) with state licensure. Must retain… more
- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Commonwealth Care Alliance (Boston, MA)
- … Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term ... a high quality team.collaboration with the broader clinical organization. * Ensures that utilization management processes are integrated with care management … more
- Saint Francis Health System (Tulsa, OK)
- …field. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License, or Clinical Social Worker (LCSW), or ... and benefits of patients, matching the level of care utilization . Assures compliance with Managed Care Behavioral ...care utilization . Assures compliance with Managed Care Behavioral Health standards in the area of UM procedures… more
- Cleveland Clinic (Vero Beach, FL)
- …+ Assist in the examination and treatment of patients under the direction of the Registered Nurse . + Identify patient physical care and comfort needs and perform ... behavioral health patients under the supervision of an LPN/ RN . + Facilitate groups, monitor and assess the mental...(ECT) preparation and provide care as designated by the Registered Nurse pre-op and post-op. + Perform… more
- Health Care Service Corporation (Downers Grove, IL)
- …liaison to providers, physicians, and members. **REQUIRED JOB QUALIFICATIONS:** * Registered Nurse ( RN ) OR Masters-level Behavioral Health Professional or ... the independent practice level) of direct clinical care to the consumer. * Utilization management , discharge planning or managed care experience. *Customer… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …acute mental health challenges by providing culturally sensitive support. This role requires a Registered Nurse ( RN ) licensed in the state of Minnesota with ... members. Required Skills and Experiences * Registered Nurse with Psychiatric experience or Behavioral Health...* 1+ years of managed care experience, eg case management /health coach, utilization management and/or… more
- UPMC (Pittsburgh, PA)
- …or licensure in a human services field. + Three years of experience in behavioral , clinical, utilization management , home care, discharge planning, and/or ... and services across the continuum of care with case management , physicians, pharmacy, behavioral health, and other...Licensed Social Worker (LSW) OR Paramedic OR Psychologist OR Registered Nurse ( RN ). Preference will… more