• Utilization Management

    Humana (Springfield, IL)
    …help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
    Humana (09/11/25)
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  • UM Behavioral Health Nurse

    Humana (Springfield, IL)
    …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work assignments are… more
    Humana (09/09/25)
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  • UM Behavioral Health Professional

    Humana (Springfield, IL)
    …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional… more
    Humana (09/04/25)
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  • ABA Utilization Review (UR) Specialist

    Spectrum Billing Solutions (Skokie, IL)
    …+ Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist | UR Specialist ... Review Specialist | ABA Utilization Review Specialist | ABA Utilization Management Specialist | ABA UR Specialist | Behavioral Health Billing… more
    Spectrum Billing Solutions (09/01/25)
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  • Utilization Review Clinician…

    Centene Corporation (Springfield, IL)
    …who reside in either central or eastern time zone with experience in mental health settings and utilization management / review. * Department: PHCO ... million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified,...regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
    Centene Corporation (08/21/25)
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  • Clinical Case Manager, Behavioral

    CVS Health (Springfield, IL)
    …+ Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate ... care issues through established channels + Ability to speak to medical and behavioral health professionals to influence appropriate member care. + Utilizes… more
    CVS Health (09/10/25)
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  • Principal Clinical Leader, Behavioral

    CVS Health (Springfield, IL)
    …years of Medicaid managed care experience + Demonstrated experience in project/program management related to behavioral health **Preferred Qualifications** + ... leadership as the subject matter expert to support the Behavioral Health needs of our ABHIL Medicaid...via internal collaboration across the various functional areas (Care Management , Utilization Management , Provider Relations,… more
    CVS Health (09/06/25)
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  • Clinical Case Manager, Behavioral

    CVS Health (Springfield, IL)
    …with heart, each and every day. **Position Summary** The Clinical Case Manager, Behavioral Health , is responsible for driving and supporting care management ... care management activities with members to ensure that their medical and behavioral health needs are met and to enhance the member's overall wellness.… more
    CVS Health (09/04/25)
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  • Behavioral Health Medical Director…

    Humana (Springfield, IL)
    …value-based care, quality metrics, population health , and disease or care management . The Behavioral Health Medical Director may develop procedures, ... part of our caring community and help us put health first** The Behavioral Health ...management , utilization management , case management , discharge planning and/or home health or… more
    Humana (08/09/25)
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  • Behavioral Health Medical…

    Elevance Health (Chicago, IL)
    ** Behavioral Health Medical Director-Psychiatrist Appeals** **Location:** This role enables associates to work virtually full-time, with the exception of ... Monday - Friday. Half day Saturday rotation, once a month.** The ** Behavioral Health Medical Director-Psychiatrist Appeals** is responsible for the… more
    Elevance Health (09/10/25)
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