- 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 ... About The Role BHPS provides Utilization Management services to its clients....* Experience with both inpatient and outpatient reviews for Behavioral Health (examples: TMS, ECT, ABA, Psychotherapy,… more
- CVS Health (Raleigh, NC)
- …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
- Brighton Health Plan Solutions, LLC (NC)
- About The Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit ... criteria sets * Experience with both inpatient and outpatient reviews including Behavioral Health , DME, Genetic Testing, Clinical Trials, Oncology, and/or… more
- Elevance Health (Durham, NC)
- ** Utilization Management Medical Director- NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of required ... be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
- CenterWell (Raleigh, NC)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous...and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral … more
- Elevance Health (NC)
- ** Behavioral Health Care Manager I - North...get an OH License_** + Previous experience in case management / utilization management with a broad range ... + Monday-Friday 9am-6pm EST + Monday-Friday 11am-8pm EST The ** Behavioral Health Care Manager I - North...preferred. + Bilingual in Spanish is highly preferred + Utilization Management experience is preferred + Previous… more
- LifePoint Health (Hickory, NC)
- Job Summary The Behavioral Health Clinical Program Therapist functions as a member of the Behavioral Health Team in providing independent practice ... levels of psychiatric care for the patients on the Behavioral Health Units. Provides and documents mental...the psychiatric crisis and the development of healthy mental health management through a biopsychosocial model of… more
- Humana (Raleigh, NC)
- …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
- Highmark Health (Raleigh, NC)
- …:** **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
- Elevance Health (Durham, NC)
- …to day clinical responsibilities means that the medical director is directly involved in Utilization Management and Case Management . + Daily case reviews for ... medical director provides clinical expertise in all aspects of utilization review and case management . Provides input...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more