- US Tech Solutions (Columbia, SC)
- …resources to promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services ... Medicare criteria. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical… more
- South Middlesex Opportunity Council (Framingham, MA)
- …individuals, children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. ... Summary: SMOC Behavioral Healthcare is a division of SMOC that...As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or… more
- Highmark Health (Bismarck, ND)
- …determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... prior authorization or appeals against medical policy through the Utilization Review system. Update the system records...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Carle Health (Champaign, IL)
- …also expected to onboard the new providers regarding utilization and case management objectives. + Conducts medical record review in appropriate cases for ... management , case management and clinical denials management . + The Behavioral Health Physician Advisor...clinical review on cases referred by Care Management staff /Social Work (remove) Utilization … more
- UNC Health Care (Hendersonville, NC)
- … behavioral health services. Working closely with behavioral health clinicians, utilization review , case management , and finance teams, the Intake ... to ensure appropriate care transition and patient placement. + Liaise with utilization review , psychiatry leadership, risk management , and/or legal… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …Experience in a managed care, case management , or utilization review setting + Strong understanding of behavioral health diagnoses, treatments, and ... + Participate in interdisciplinary case rounds, quality improvement initiatives, and utilization review processes. + Support members during transitions of… more
- Immigration and Customs Enforcement (Jena, LA)
- … health provider peer reviews to include completion and dissemination of peer review reports to IHSC behavioral health unit administration for program and ... Summary The Supervisory Behavioral Health Provider oversees clinical performance, program evaluations, and behavioral health services at ICE detention… more
- East Boston Neighborhood Health Center (MA)
- …the preparation and monitoring of the departmental budget; BHC productivity/ utilization review , and documentation/coding/billing practices and improvements. ... services, IBH, Specialty, and all other clinical programs assigned. 18.Provides programmatic management and oversight of access and utilization data to the… more
- City and County of San Francisco (San Francisco, CA)
- …positions can review your application Under direction, the 2932 Senior Behavioral Health Clinician performs essential duties that include, but are not limited to ... and others; + May conduct group psychotherapy and case management on a scheduled basis in connection with administering...Quality Improvement activities such as chart audit and compliance review . + The 2932 Senior Behavioral Health… more