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Behavioral Health Utilization Management Jobs

Utilization Management Behavioral Health Professional
By Humana At , Brentwood, 37027, Tn
Utilization management experience, preferably in an outpatient setting.
Coordinates with Care Coordination and Case Management.
Three (3) or more years of post-degree clinical experience in direct patient care.
Three (3) or more years of Behavioral Health experience.
Experience working in electronic medical records.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Utilization Management Clinician - Behavioral Health
By PacificSource Health Plans At , Helena, Mt
Identify high cost utilization and refer to Large Case Reinsurance RN and Care Management team as appropriate.
Coordinate necessary resources to achieve member outcome goals and objectives.
Accurately document case notes and letters of explanation which may become part of legal records.
Perform concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization programs.
Maintain contact with the inpatient facility utilization review personnel to assure appropriateness of continued stay and level of care.
Review referral and preauthorization requests for appropriateness of care within established evidence-based criteria sets.
Rn Utilization Review/Case Management - Behavioral Health
By PeaceHealth At , Springfield, 97477, Or
Maintains issue tracker related to third party denials and interfaces with management as needed to initiate investigation of denials.
Oversees and supports staff with wound care and patient education.
Attends unit leadership meetings. Collaborates regarding unit issues and quality assurance. Provides staff education as appropriate.
Working knowledge of psychiatric diagnostics required
Third party reimbursement knowledge desirable
Willingness to work toward CPUR certification preferred
Manager, Behavioral Health Utilization Management Remote
By Banner Health At , Tucson, 85719, Az

While this role is remote you must reside and be licensed in the state of Arizona.

Our organization supports a drug-free work environment.

Behavioral Management Technician Ii
By Tulane University At , Covington, La
Certification as an AALAS LAT with 4 years of experience in laboratory animal care OR
Must have basic computer skills
Bachelor's Degree with a background in behavioral sciences with 2 years of experience in laboratory animal care OR
6 years of experience in laboratory animal care
Organizes and performs technical duties, such as preparation, maintenance and distribution of enrichment materials, devices and equipment.
Identifies animals that are in need to specialized intervention for observed behavioral problems and implements intervention practices to improve behavior.
Rn, Utilization Management - Behavioral Health
By Humana At , Rogers, 72758, Ar
One (1) year of managed care experience working directly with insurance companies.
Complete additional responsibilities as deemed appropriate by Humana leadership
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Minimum of three (3) years of post-degree clinical experience as an RN in direct patient care with an adult population.
Must have 1-3 years of experience in Behavioral Health.
Adept experience working with computers and comfortable learning new programs.
Behavioral Health Case Management Nurse / Job Req 587496071
By ALAMEDA ALLIANCE FOR HEALTH At , Alameda, 94502, Ca $121,730 - $182,595 a year
Three years clinical case management or behavioral health experience in required
Experience in use of Care Management Software applications a plus.
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
Communicate with providers, members, and community resources as necessary, to support the planning, implementation and evaluation of care management programs.
Experience with Medi-Cal program, Department of HealthCare Services and Department of Managed HealthCare preferred.
Carry a caseload of members individually and co-managed as a team
Specialist, Utilization Management-Mental Health
By Kaiser Permanente At , Portland, Or $42.50 - $54.94 an hour
Minimum two (2) years of experience in utilization management and discharge planning.
Excellent written and verbal communication skills; presentation skills; analytical problem-solving skills; well developed project management skills; and competent quantitative skills.
Knowledge of how behavioral health benefits work.
Knowledge of Kaiser Permanente resources, Behavioral Health system and benefits.
Member contact. Member contact may occur for a variety of reasons which can include benefit explanations, resource identification and appointment scheduling.
Knowledge of DSM-IV diagnoses, community standards of treatment and treatment interventions for mental health, addictions and co-occurring disorders.
Utilization Management Clinician - Behavioral Health
By PacificSource Health Plans At , Springfield, 97477, Or
Identify high cost utilization and refer to Large Case Reinsurance RN and Care Management team as appropriate.
Coordinate necessary resources to achieve member outcome goals and objectives.
Accurately document case notes and letters of explanation which may become part of legal records.
Perform concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization programs.
Maintain contact with the inpatient facility utilization review personnel to assure appropriateness of continued stay and level of care.
Review referral and preauthorization requests for appropriateness of care within established evidence-based criteria sets.
Behavioral Health Specialist Iii / Qualified Professional / Qp / Mobile Crisis Management / Fulltime
By RHA Health Services, LLC At Asheville, NC, United States
Performing Case Management functions of linking and arranging for services and referrals
Chronic Disease management programs for hypertension and diabetes (for qualifying employees)
We offer the following benefits to employees:
Bachelor Degree (Not Human Services field) & 4+ years full-time experience with population served
Bachelor Degree (in Human Services field) & 2+ years full-time experience with population served
Master’s Degree or Higher & 1+ years full-time experience with population served.
Utilization Management Clinician - Behavioral Health
By PacificSource Health Plans At , Idaho Falls, 83402, Id
Identify high cost utilization and refer to Large Case Reinsurance RN and Care Management team as appropriate.
Coordinate necessary resources to achieve member outcome goals and objectives.
Accurately document case notes and letters of explanation which may become part of legal records.
Perform concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization programs.
Maintain contact with the inpatient facility utilization review personnel to assure appropriateness of continued stay and level of care.
Review referral and preauthorization requests for appropriateness of care within established evidence-based criteria sets.
Utilization Management Clinician - Behavioral Health
By CVS Health At , , Ia $58,760 - $125,840 a year
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
1+ years of utilization review/utilization management required
Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
3+ years of behavioral health clinical experience in a hospital setting required
Experience working with geriatric population
Behavioral Health Case Management Coordinator (Tx, Ok, Nm, Il)
By HCSC At , Richardson, Tx
Utilization management, discharge planning or managed care experience.
Familiarity with Utilization Management or Case Management activities and standardized criteria sets.
2 years clinical experience (post licensure at the independent practice level ) of direct clinical care to the consumer.
Verbal and written communication skills
3 years clinical practice experience .
3 years clinical practice experience
Rn, Utilization Management - Behavioral Health
By Humana At , Overland Park, 66213, Ks
One (1) year of managed care experience working directly with insurance companies.
Complete additional responsibilities as deemed appropriate by Humana leadership
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Minimum of three (3) years of post-degree clinical experience as an RN in direct patient care with an adult population.
Must have 1-3 years of experience in Behavioral Health.
Adept experience working with computers and comfortable learning new programs.
Rn, Utilization Management - Behavioral Health
By Humana At , Aberdeen, 57401, Sd
One (1) year of managed care experience working directly with insurance companies.
Complete additional responsibilities as deemed appropriate by Humana leadership
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Minimum of three (3) years of post-degree clinical experience as an RN in direct patient care with an adult population.
Must have 1-3 years of experience in Behavioral Health.
Adept experience working with computers and comfortable learning new programs.
Behavioral Health Inpatient Case Management Lead Analyst- Evernorth Health Services - Remote
By Cigna At , Hartford, 06152, Ct $62,400 - $104,000 a year

The ideal candidate for this position is a licensed professional with a background in the insurance industry as a care manager in a behavioral healthcare role, or an individual who has worked in a ...

Medicaid Utilization Management Behavioral Health Professional
By Humana At , Lancaster, 29720, Sc
1 year experience in utilization management
1 year experience in case management
Workstyle: Remote work at home
3+ years of Human Services/Behavioral Health experience
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Must be passionate about contributing to an organization focused on continuously improving consumer experiences with integrated care approach
Cigna Medicare Behavioral Health Case Management Senior Analyst - Remote
By Cigna At , Nashville, 37214, Tn $54,700 - $91,100 a year

Performs utilization management duties for Cigna Healthcare members following national and state clinical guidelines for inpatient and outpatient Medicare and Medicaid covered services. Participates ...

Rn, Utilization Management - Behavioral Health
By Humana At , Bethesda, 20817, Md
Utilization management experience, performing medical necessity reviews against criteria such as MCG, ASAM, Interqual, etc.
1 year of managed care experience working directly with insurance companies
Complete additional responsibilities as deemed appropriate by Humana leadership
Minimum 3 years of post-degree Clinical experience in direct patient care (either medical or behavioral health)
Adept experience working with computers, including proficiency with Microsoft Office products: Word, Excel and MS Teams and OneNote
Behavioral Health direct patient care experience preferred
Behavioral Health - Utilization/Case Manager
By Mercy At , Chesterfield, 63017, Mo
Position can be done Remote (work from home)
Education: Registered Nurse or Masters in Social Work, Counseling or Psychology.
Broad Knowledge of mental illness/substance use diagnosis and treatment protocols required.
Computer skills and an advanced understanding of the Electronic Health Records used by the department required.
The abilities to work independently to triage incoming requests and clearly communicate work assignments and priorities to the department are essential.
Overview: Behavioral Health (Utilization/Case Manager)