- Omaha Children's Hospital (Omaha, NE)
- …equal opportunity employer including veterans and people with disabilities. **A Brief Overview** Utilization Management (UM) is a specialty area of Nursing Case ... a wide variety of settings. + Skills in negotiation and problem solving with utilization management . + Should be a creative, flexible, risk taker. **Licenses and… more
- Molina Healthcare (Rochester, NY)
- …and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …experience within insurance or health care setting in case/disease or utilization management * 3+ years of behavioral health experience * Bachelor's or ... , and business case consultant for leadership as they relate to case/disease/ utilization management . * Coordinates the development, revision and implementation… more
- Spectrum Billing Solutions (Skokie, IL)
- …Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist | UR Specialist | ... Review Specialist | ABA Utilization Review Specialist | ABA Utilization Management Specialist | ABA UR Specialist | Behavioral Health… more
- AmeriHealth Caritas (Washington, DC)
- …BONUS** **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient ... are escalated to the Medical Director for further review . The reviewer independently applies medical and behavioral health guidelines to authorize services,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …healthcare? Bring your true colors to blue. The Role The Physical Therapy Utilization Management Reviewer is responsible for evaluating the appropriateness ... member's benefit to provide the best quality care. The Team The commercial Physical Therapy Utilization Management Reviewer is part of a highly dedicated and… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for members who may ... use of the member's benefit to provide the best quality care. The TeamThe Clinical Utilization Reviewer is part of a highly dedicated and motivated team of… more
- Centene Corporation (Indianapolis, IN)
- …Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Centene Corporation (Atlanta, GA)
- …Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Centene Corporation (Richmond, VA)
- …appeals, and occasional peer-to-peer consultations, as well as participating in Utilization Management clinical rounds.** **We're seeking candidates who:** + ... Kentucky license with a passion for improving access to behavioral health care? Centene is looking for a Remote...practitioners to provide education on best practice models and utilization management processes + Interact with the… more
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