- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …Ideal Candidates will have an RN or Social Work license and:** + **3 years** \- Clinical behavioral health / substance use disorder experience required + **1 ... and member appeals, denial interpretation for letters, retrospective claim review , special review requests, and UM pre\-certifications...Nurse Licensure Compact Law\. _Experience_ + 3 years \- Clinical behavioral health / substance… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …+ Extensive knowledge of all aspects of Utilization Management, Care Management, and Behavioral Health \. + Knowledge and understanding of Medical terminology + ... **BCBST is seeking a Clinical Assistant to join our Senior Care team\.**...customer inquiries and claims\. Maintain departmental goals\. Perform projects, review and handle reports as assigned\. + Load complete… more
- Elevance Health (Nashville, TN)
- ** 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
- Humana (Nashville, TN)
- …of experience post-training providing clinical services . Experience in utilization management review and case management in a health plan setting . No ... part of our caring community and help us put health first** The Behavioral Health ...work in their assigned cluster + Work includes computer-based review of moderately complex to complex clinical … more
- Humana (Nashville, TN)
- …our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge ... of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments are varied and… more
- Veterans Affairs, Veterans Health Administration (Memphis, TN)
- …appropriate to patients, family members, and significant others regarding mental and behavioral health concerns. Provides clinical services using ... VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities VA Careers -...and consultation in areas related to professional psychology and behavioral health . Knowledge of clinical … more
- Highmark Health (Nashville, TN)
- …+ Leads the design, development, execution, dissemination and interpretation of clinical and population health analyses, metrics and reports using ... administrative data to identify, develop and/or monitor actionable opportunities for improving health and healthcare outcomes and clinical quality and costs of… more
- HCA Healthcare (Brentwood, TN)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... **Introduction** Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want...Parallon offers a total rewards package that supports the health , life, career and retirement of our colleagues. The… more
- Veterans Affairs, Veterans Health Administration (Memphis, TN)
- …professional advice and consultation in areas related to professional psychology and behavioral health . Knowledge of clinical research literature. Reference: ... Veteran with PTSD. Complies with national and local performance measures, including timely health care screening and completion of clinical reminders for all… more
- Maxim Healthcare (Brentwood, TN)
- The Clinical Operations Specialist is responsible for the agreed-upon clinical activities that help facilitate and improve the day-to-day clinical operations ... office. The position will be multifunctional that focuses on overall clinical and operational coordination and creating efficiencies with standardization. Essential… more
