- Humana (Madison, WI)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... action. + Minimum one, (1) year of experience in Behavioral Health Nursing (inpatient outpatient, psych, substance...Nursing experience + Previous experience in utilization management with ASAM knowledge + Health Plan… more
- Humana (Madison, WI)
- …Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health ; MED-Deeming accreditation standards ... degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management...knowledge is a plus. + Registered Nurse or Behavioral Health Licensed Professional. + Managed care,… more
- Humana (Madison, WI)
- …part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work… more
- Evolent (Madison, WI)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Molina Healthcare (Racine, WI)
- …with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization ... **JOB DESCRIPTION** **Job Summary** Molina's Behavioral Health function provides leadership and... Health function provides leadership and guidance for utilization management and case management … more
- Vighter Medical Group (Big Bend, WI)
- Supervisory Behavioral Health Advisor (SBHA), Local, Big Bend, Texas Job Details Job Location Big Bend, TX - Big Bend, TX Position Type Full Time Education Level ... Percentage Up to 25% Job Shift Any Job Category Health Care Description Title:Supervisory Behavioral Health...of sector wide BH programing to optimize access and utilization . + Provide professional direction, oversight, and consultation of… more
- Elevance Health (Waukesha, WI)
- ** Behavioral Health Medical Director- Psychiatrist** Location: Alternate locations may be considered. This position will work a hybrid model (remote and office). ... 50 miles of an Elevance Health Pulse Point location. The ** Behavioral Health Medical Director- Psychiatrist** is responsible for completing medical necessity… more
- Molina Healthcare (WI)
- …equivalent experience * 2 or more years in case, disease, or utilization management ; managed care; or medical/ behavioral health settings. * Proficient in ... development, implementation, and collaboration with the delivery of training curriculum for Utilization Management , Case Management , and LTSS staff. **Job… more
- Centene Corporation (Madison, WI)
- …functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate,… more
- Highmark Health (Madison, WI)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more