- Molina Healthcare (Sacramento, CA)
- …**Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM), Certified Professional in Health Care ... plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential.… more
- Commonwealth Care Alliance (Boston, MA)
- …Utilization Mgmt * Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and ... of health plan QI Committee. Co-chair of health plan Utilization Management Committee...five (5) years of clinical experience in medical or behavioral health care delivery Required Knowledge, Skills… more
- Saint Francis Health System (Tulsa, OK)
- …matching the level of care utilization . Assures compliance with Managed Care Behavioral Health standards in the area of UM procedures and documentation to ... therefrom or Master's degree in Social Work, Counseling or related behavioral health field. Licensure, Registration and/or Certification: Valid multi-state… more
- Brighton Health Plan Solutions, LLC (NC)
- About The Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit ... criteria sets * Experience with both inpatient and outpatient reviews including Behavioral Health , DME, Genetic Testing, Clinical Trials, Oncology, and/or… more
- Houston Behavioral Healthcare Hospital (Houston, TX)
- …team at Houston Behavioral Healthcare Hospital strives to be the leaders in Behavioral Health by delivering quality services to those entrusted in our care. ... Houston Behavioral Healthcare Hospital (HBHH) is unique in so...Healthcare Hospital (HBHH) currently has an opening for Part-time Utilization Management Coordinator. The Utilization … more
- AmeriHealth Caritas (Washington, DC)
- …products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more ... Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …reproductive and gender affirming health , preferred. + 2-3 years of Utilization Management experience. + Active licensure in Massachusetts is required, ... highly dedicated and motivated team of professionals, including medical and behavioral health care managers, dieticians, pharmacist, clinicians, medical… more
- Health Care Service Corporation (Downers Grove, IL)
- …in your professional development. **Job Summary** This position is responsible for performing behavioral health case management in accordance with accepted ... physicians, and members. **REQUIRED JOB QUALIFICATIONS:** *Registered Nurse (RN) OR Masters-level Behavioral Health Professional or Doctoral degree in a … more
- Helio Health Inc. (Syracuse, NY)
- …mission to treat and promote recovery from the effects of substance use, mental health disorders, and other behavioral healthcare issues. To support the mission ... staff on current principles and standards of practice surrounding utilization and denials management . + Use effective...Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care,… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- …This position evaluates the efficiency, appropriateness, and clinical necessity of mental health , behavioral health and substance abuse treatment services ... a web-based application for daily entry of case activity and the utilization management of service authorizations. Educational and Experience Requirements: MA/MS… more