- 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
- The Cigna Group (Bloomfield, CT)
- …not be included in CMS' Preclusion List** **Preferred Skill Sets:** + Experience in medical management , utilization review and case management in a ... description of position** : A Medical Principal performs medical review and case management activities. The physician...will serve as a clinical educator and consultant to utilization management , case management , network,… more
- Molina Healthcare (Rio Rancho, NM)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN (preferred) or LPN with a compact license who resides in New Mexico or Texas. This team ... 3-5 years clinical practice with managed care, hospital nursing or utilization management experience. **Preferred License, Certification, Association** Active,… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …a difference, join us. The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre ... policies and procedures to determine clinical appropriateness. * Completes review of both medical documentation and claims data to...* 1+ years of managed care experience (eg case management , utilization management and/or auditing… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. * Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... in behavioral health clinical practice, provider relations, or healthcare management Desired Experience (nice to have): * Experience working with managed care… more
- Bakersfield Behavioral Healthcare Hospital (Bakersfield, CA)
- …risk management , infection control, environmental safety, quality control, and utilization review ; strong oral and written communication skills, current ... About Us Bakersfield Behavioral Healthcare Hospital, located in Bakersfield, California, is...communication skills. Job Summary Leads the Quality and Risk Management Team through Process Improvement initiatives at the hospital.… more
- Commonwealth of Pennsylvania (PA)
- …calls, personal visits, and review of treatment progress reports; conduct utilization review . Orient clients to the program, policies, procedures, and ... Drug & Alcohol Case Management Specialist (Local Government) - Delaware County D&A...clients or discharge planning via telephone, personal visits, or review of treatment progress reports; conducting utilization … more
- Elevance Health (Wilmington, NC)
- …and overseeing assigned care managers and ensuring fidelity to the CFSP Care Management model which includes physical health, behavioral health, and social ... **Manager Care Management , Foster Care (Manager I GBD Special Programs)**...the same basic benefits and services, including Physical health, Behavioral health, Pharmacy,_ _Intellectual/Developmental_ _Disabilities (I/DD) services, long term… more
- Sevita (Detroit, MI)
- …states to increase census, maintain occupancy, improve daily attendance, and maximize utilization . + Financial Management : + Oversee billing to ensure accuracy ... infants, children, adolescents, Military Service Members and Veterans. **Operations Management Executive Director - State of MI** **Compensation: $140,000-$160,000/year… more