- Centene Corporation (Harrisburg, PA)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... **THIS POSITION IS REMOTE/WORK FROM HOME SUPPORTING PENNSYLVANIA HEALTH & WELLNESS BEHAVIORAL HEALTH UTILIZATION MANAGEMENT.** **APPLICANTS MUST EITHER HOLD AN… more
- CVS Health (Harrisburg, PA)
- …in a hospital setting required for either BH or RN -1+ years of utilization review / utilization management required (ie concurrent review , ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in… more
- Centene Corporation (Harrisburg, PA)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... state (BCBA) required. Master's degree for behavioral health clinicians required. Behavioral health clinical knowledge and ability to review and/or… more
- Highmark Health (Harrisburg, PA)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
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