- AmeriHealth Caritas (LA)
- **Role Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing ... products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more… more
- CVS Health (Baton Rouge, LA)
- …working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal departments. + ... management program. + Conduct clinical reviews for adult inpatient behavioral health cases, applying established medical necessity criteria to ensure… more
- AmeriHealth Caritas (Lafayette, LA)
- …products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more ... **Role Overview:** Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient services,… more
- CenterWell (Baton Rouge, LA)
- …+ Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus + Previous Medicare ... clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence +… more
- Humana (Baton Rouge, LA)
- …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
- Elevance Health (Metairie, LA)
- …with some rotating weekends and holidays as required by business needs. The ** Behavioral Health Care Manager** **I** **-** **Louisiana** is responsible for ... Requires MA/MS in social work counseling or a related behavioral health field or a degree in...qualifications, skills, and experiences: + Previous experience in case management / utilization management with a broad… more
- CVS Health (Baton Rouge, LA)
- …acknowledges physicians for their clinical excellence and effective utilization of health care resources. Reporting to the Executive Behavioral Health ... members across Aetna. **Expectations and Responsibilities:** * Serve as the principal utilization management reviewer for cases related to Applied Behavior… more
- CVS Health (Baton Rouge, LA)
- …company policies and procedures. **Required Qualifications** + 2+ years' experience in behavioral health , social services or appropriate related field equivalent ... degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (ie, psychology, social work,… more
- Highmark Health (Baton Rouge, LA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- Highmark Health (Baton Rouge, LA)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more