- Humana (Albany, NY)
- …our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work assignments are… more
- CVS Health (Phoenix, AZ)
- …be at the forefront of clinical decision-making, applying your expertise in Behavioral Health to ensure members receive appropriate, evidence-based care. You'll ... **Position Summary** We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team....Apply critical thinking and evidence-based clinical criteria specific to Behavioral Health to evaluate inpatient and outpatient… more
- 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
- CVS Health (Richmond, VA)
- …across broader Plan operations. **Required Qualifications:** + Must reside within Virginia. + Registered Nurse with 5 years Behavioral Health Experience or ... plan and collaborate with internal partners, community organizations, and behavioral health and ARTS providers to enhance... clinical issues as they relate to medical management ( UM , CM, DM) provider and system of care issues,… more
- AmeriHealth Caritas (LA)
- **Role Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical ... cases to integrated care management as needed. The BH UM Reviewer will apply medical health benefit...in Social Work + Minimum of 2 years of behavioral health experience and substance use disorder… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …those with varied clinical expertise (ex. Social Work, Behavioral Health , Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, ... health care services. Examples may include: Utilization Management, Quality, Behavioral Health , Pharmacy, Registered Dietitian and Respiratory Therapist +… more
- Corewell Health (Grand Rapids, MI)
- …reviews and appeals. Additional support to the UM functions of the Corewell Health South Behavioral Health Inpatient unit. + Assesses internal and ... Friday (4 hours), mostly remote, occasional on-site About the Department: RN UM - Supporting the insurance coordination functions for the Helen DeVos Children's… more
- Brighton Health Plan Solutions, LLC (NC)
- …criteria sets * Experience with both inpatient and outpatient reviews including Behavioral Health , DME, Genetic Testing, Clinical Trials, Oncology, and/or ... Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in...URAC and NCQA. * 2+ years' experience in a UM team within managed care setting. * 3+ years'… more
- Highmark Health (Jackson, MS)
- …panel. Provides oversight over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of ... various resources to assist members in achieving their personal health goals. Will work with providers to insure quality...in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced training and… more
- University of Michigan (Ann Arbor, MI)
- REGISTERED NURSE : University Hospital (9C Adult Psychiatry Unit) Apply Now **Job Summary** The Adult Inpatient Psychiatry Unit (9C) offers inpatient diagnostic ... both patients and families. **Mission Statement** Michigan Medicine improves the health of patients, populations and communities through excellence in education,… more