- St. Luke's University Health Network (Allentown, PA)
- …for admission and/or referral to appropriate level of care. + May assist in the utilization management of psychiatric cases in the absence of the utilization ... mental health illness. Previous experience in discharge planning and case management models preferred.Current Behavioral Health department program for… more
- CVS Health (Springfield, IL)
- …+ Case management and discharge planning experience. + Managed care/ utilization review experience. + Crisis intervention skills. + Strong analytical ... work. Services and strategies, policies and programs are comprised of network management , clinical coverage, and policies. **Position Summary** Our Case Managers use… more
- Atlantic Health System (NJ)
- …chart documentation. 8. Incorporates use of criteria sets in context of utilization management . 9. Performs other related duties as assigned. Required:1. ... plans. 2. Engages to enhance functioning, effective coping, illness management , self- management , wellness and quality of life....100 Accountable Care Organizations to Know - Becker's Hospital Review + Best Employers for Workers over 50 -… more
- Healthfirst (NY)
- …out of home placement, and//or community-based services and may be called upon to do Utilization Review for those services + Develops care plans that align with ... + Applies care management principles by advocating, informing, and educating beneficiaries...principles by advocating, informing, and educating beneficiaries on services, self- management techniques, and health benefits related to the continuum… more
- Saint Francis Health System (Muskogee, OK)
- …Skills and Abilities: Working knowledge of general disease state management processes, bio-psychosocial model, and clinical pathways. Effective interpersonal, ... toward goals. Facilitates patient discharge through timely, appropriate referrals and utilization of patient education resources, suitable to patient age and… more
- Highmark Health (Pittsburgh, PA)
- …in planning/marketing strategy to ensure referral sources. + Participates in peer utilization and/or review and assists in coordination of related quality ... clients as assigned to assess urgency of client need and recommend appropriate management . Provides on call coverage to caseload and for staff coverage to assess… more
- Ventura County (Ventura, CA)
- …medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality Assurance Staff. + Participates, as ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …services. The position works closely with the Medical Director of Utilization Management and the Medical Director of Behavioral Health services to facilitate ... to peer calls. Acts as a resource for the peer review process in the Health Management Division. * Develops and maintains processes specific to position… more
- CVS Health (Richmond, VA)
- …involving members across Aetna. **Expectations and Responsibilities:** * Serve as the principal utilization management reviewer for cases related to Applied ... of health care resources. Reporting to the Executive Behavioral Health Medical Director, Aetna Medicaid, this role is...Attend and actively participate in clinical meetings with care management and utilization management teams,… more
- Molina Healthcare (Louisville, KY)
- …with multidisciplinary teams to promote Molina care model. * Adheres to utilization management (UM) policies and procedures. * May work collaboratively ... required. JOB DESCRIPTION Job Summary Provides support for member clinical service review processes specific to behavioral health. Responsible for verifying that… more