- AmeriHealth Caritas (LA)
- **Role Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical ... all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer's discretion...in Social Work + Minimum of 2 years of behavioral health experience and substance use disorder… more
- UNC Health Care (Hendersonville, NC)
- …for behavioral health services. Working closely with behavioral health clinicians, utilization review , case management, and finance teams, the ... This role involves the review , coordination, and tracking of behavioral health referrals, ensures adherence to safety protocols, age-appropriate clinical… more
- Spectrum Billing Solutions (Skokie, IL)
- …(Word, Excel, billing software). + Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization ... Utilization Management Specialist | ABA UR Specialist | Behavioral Health Billing Specialist #UtilizationReviewSpecialist | #UtilizationManagementSpecialist… more
- Health Care Service Corporation (Albuquerque, NM)
- …**Job Summary** This position is responsible for ensuring accurate and timely clinical review of behavioral health cases (Applied Behavior Analysis (ABA)) ... reviewing medical records, reviewing cases which involves contract interpretation of behavioral health diagnoses, and utilizing knowledge of medical necessity… more
- Centene Corporation (Austin, TX)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and...health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review… more
- CVS Health (Austin, TX)
- …not accepting applicants whose only acute care experience is in behavioral health ) **Preferred Qualifications** + 1+ years' experience Utilization Review ... At CVS Health , we're building a world of health...Job Description Primary Job Duties & Responsibilities Drives effective utilization management practices by ensuring appropriate and cost-effective allocation… more
- MVP Health Care (Rochester, NY)
- …For in New York** , and an **Inclusive Workplace** . The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental ... with at least 2 years being ASD related + Utilization or Case Management experience in a managed care...our customers in every interaction **Your key responsibilities:** + Review all requests for behavioral health… more
- CVS Health (Harrisburg, PA)
- …clinically appropriate treatment, evidence based care an clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. - ... One of the following is required: Unencumbered Master's Level Behavioral Health clinical license in the state...required for either BH or RN -1+ years of utilization review / utilization management required (ie… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …a member's benefit coverage while working remotely. Primary Responsibilities * Performs behavioral health clinical utilization reviews using evidenced based ... pace and changing environment- flexibility in assignment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical… more
- CVS Health (Phoenix, AZ)
- …be at the forefront of clinical decision-making, applying your expertise in Behavioral Health to ensure members receive appropriate, evidence-based care. You'll ... Apply critical thinking and evidence-based clinical criteria specific to Behavioral Health to evaluate inpatient and outpatient...intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or… more
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