• Blue Shield of California (Oakland, CA)
    Job Description Your Role The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level ... nationally recognized clinal criteria across multiple lines of business. The Behavioral Health Utilization Management Clinician, Experienced, will report… more
    Upward (07/21/25)
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  • Blue Shield of California (El Dorado Hills, CA)
    …policies, and nationally recognized clinical criteria across multiple lines of business. The Behavioral Health Utilization Management , Consultant (Lead), ... will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will support the clinicians with daily operations,… more
    Upward (07/20/25)
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  • Optum (Hot Springs National Park, AR)
    …to care. Primary Responsibilities: Care management , case management and utilization review of behavioral health services This includes authorization, ... Join us to start Caring. Connecting. Growing together. Qualified Behavioral Health Providers are case managers in... management services through review and evaluation of behavioral health treatments for medical necessity, emergency… more
    Upward (07/21/25)
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  • AmeriHealth Caritas Health Plan (Washington, DC)
    …products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more ... Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services,… more
    Upward (07/18/25)
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  • MemorialCare (Fountain Valley, CA)
    Description Title: LMFT, Behavioral Health Specialist Location: Fountain Valley Department: Behavioral Health Program Status: Full-time Shift: Day Pay ... As a member of the Care Team, the LMFT Behavioral Health Specialist is a core member...of the Medical Foundation provider clinics and centralized Medical Management services. Monitor and implement all regulatory changes impacting… more
    Upward (07/23/25)
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  • McLaren Health Care Corporation (Indianapolis, IN)
    We are looking for a Utilization Management RN, to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of ... MDwise, Inc. at https://www.mdwise.org/. Position Summary: This position is responsible for utilization management functions. This includes but is not limited to… more
    Upward (07/13/25)
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  • Conway Behavioral Health (Conway, AR)
    PURPOSE STATEMENT: Provide administrative support to the Utilization department. ESSENTIAL FUNCTIONS: Perform pre-certification and negotiate continued stay with ... party payers in a professional manner. Gather data to support case management activities, including presentation of gathered data and case notes. Verbally present… more
    Upward (06/24/25)
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  • EvergreenHealth (Kirkland, WA)
    …care teams are composed of the following: Social Workers provide crisis intervention, behavioral health and chemical dependency assessments, screen for abuse and ... arrange for equipment, and arrange for additional services in the community. Utilization Management /Case Management Nurses provide clinical information to… more
    Upward (07/06/25)
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  • PacificSource (Medford, OR)
    …and functional abilities in order to develop a comprehensive, individualized care management plan that promotes appropriate utilization , and cost-effective care ... develop and utilize each person's talents and strengths. Case management is a collaborative process that assesses, plans, implements,...the options and services required to meet the client's health and human service needs. It is characterized by… more
    Upward (07/23/25)
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  • AmeriHealth Caritas Health Plan (Washington, DC)
    …in the development and implementation of medical policy as it relates to behavioral health management Maintains compliance with applicable regulatory ... procedures, and contractual obligations Works closely with a multidisciplinary team to ensure behavioral health management and quality management more
    Upward (07/01/25)
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