- Humana (Jefferson City, MO)
- …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
- Evolent (Jefferson City, MO)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Highmark Health (Jefferson City, MO)
- …coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Elevance Health (St. Louis, MO)
- ** 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 (St. Louis, MO)
- …medical benefits, including medical management . **Hours: 8am-5pm (Local time)** The ** Behavioral Health Care Manager I** is responsible for managing adult ... ** Behavioral Health Care Manager I -...** Behavioral Health Care Manager I - Ameriben** **Location** :...Skills, Capabilities and Experiences:** + Previous experience in case management / utilization management with a broad… more
- BJC HealthCare (St. Louis, MO)
- …Manager. This is an **onsite** role that will be working with our Behavioral Health group. Ideal candidate will have experience in **Performance Improvement** ... and **Lean Six Sigma** . **Overview** **BJC Behavioral Health ** is a community ...+ Serve as Executive level coach on the effective utilization and employment of the BJC High Reliability System… more
- Highmark Health (Jefferson City, MO)
- …This role supports the full application product lifecycle for **clinical and utilization management software** , with a specific focus on driving ... function as a pivotal bridge, translating high-level **clinical and utilization management software** business needs into detailed...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Jefferson City, MO)
- …:** **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
- Blue KC (MO)
- …our members and communities. + Lead cross-functional efforts to embed behavioral health principles into population health management , product design, and ... Health Advancement Program Manager leads an integrated behavioral health and health outcome...of experience in integrated care, managed care, or population health program management . + 3+ years of… more
- Highmark Health (Jefferson City, MO)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... decisions, ensuring alignment with the Quadruple Aim of Healthcare: lower per capita health care costs, improved outcomes and quality of care received, and optimal… more