• Utilization Management…

    CVS Health (Washington, DC)
    …No weekends or holidays. + 1+ years of utilization review/ utilization management required. + 3+ years of behavioral health clinical experience in a ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
    CVS Health (01/16/26)
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  • LTSS Service Coordinator - RN Clinician

    Elevance Health (Arlington, VA)
    …an accommodation is granted as required by law._ The **LTSS Service Coordinator RN Clinician ** is responsible for overall management of member's case within the ... face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral … more
    Elevance Health (11/13/25)
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  • Payment Integrity Clinician

    Highmark Health (Washington, DC)
    …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
    Highmark Health (11/14/25)
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