- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …member's benefit coverage while working remotely. Primary Responsibilities * Performs behavioral health clinical utilization reviews using evidenced based ... and CMS criteria sets * Experience with both inpatient and outpatient reviews for Behavioral Health (examples: TMS, ECT, ABA, Psychotherapy, IOP, PHP, IP Stays,… more
- Elevance Health (Winston Salem, NC)
- …terminology training and experience in medical or insurance field preferred. + Behavioral health medical terminology strongly preferred. + For URAC accredited ... requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data...identification and data entry of referral requests into the UM system in accordance with the plan certificate. +… more
- Highmark Health (Raleigh, NC)
- …effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource ... utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and… more