- Hartford HealthCare (Danielson, CT)
- …which may include staff scheduling, scheduling clinical activities, program development, utilization review , case load assignment, and attending meetings as ... and then to the student's home. *_Job Summary_* Lead Behavioral Health Clinician works in coordination with interdisciplinary teams to organize, prepare,… more
- FLACRA (Penn Yan, NY)
- …within the timelines outlined by FLACRA. + Participates in quality initiatives and utilization review activities as requested. + Strives to understand and meet ... Integrated Outpatient Senior Clinician FLACRA Penn Yan, NY (Onsite) Full-Time $34.00/Hour...staff and community service providers. + Knowledge of local behavioral health service system. + Ability to multi-task, have… 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 ... degree in a healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of… more
- HCA Healthcare (Dallas, TX)
- …interdisciplinary team members, payer representatives, and other parties as appropriate regarding behavioral services** + **Performs utilization review as ... hours volunteering in our communities. As a(an) Licensed Intake Clinician - PRN with Medical City Green Oaks Hospital...for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services… more
- Molina Healthcare (Sparks, NV)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- Highmark Health (Little Rock, AR)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Molina Healthcare (Akron, OH)
- **JOB DESCRIPTION** Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- CVS Health (Frankfort, KY)
- …with heart, each and every day. **Position Summary** This is a fully **remote** Utilization Review Clinical Consultant. **Must reside in the state of Kentucky or ... the standard schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Foster Care population experience +… more
- Point32Health (MA)
- …the Utilization Management Supervisor, the Behavioral Health (BH) Utilization Management (UM) Clinician is responsible for conducting benefit coverage ... management and care management principles. Health Plan experience performing utilization review activities. Experience with McKesson's InterQual Clinical… more
- Prime Healthcare (Boonton Township, NJ)
- …meetings as required to ensure continuity of care. Completes all required utilization review tasks as assigned. For Outpatient and Residential services/programs ... of hospitals and healthcare facilities include Denville Hospital, Dover Hospital, Behavioral Health Centers in Boonton, Denville, and Parsippany, and an Imaging… more