Register
Recruit Create CV

Behavioral Health Utilization Management Jobs

Behavioral Health Therapist - Utilization Review - Days
By Integris Health At , Spencer
2 years Mental Health experience preferred.
The Therapist responsibilities include, but are not limited to, the following:
Provides documentation daily in the chart of each patient.
Facilitates discharge planning to assist patients in placement and treatment following discharge from current level of care.
Participates in the writing of treatment plans and attends treatment team meetings.
Facilitate the completion of Emergency Detention paperwork as well as ensure its distribution and receipt by legally designated individuals.
Psychotherapist - Atrium Health Behavioral Health Billingsley - Initial Stage Psychosis Management Youth - Ft Day
By Atrium Health At , Charlotte, 28211
Manages clients in crisis utilizing appropriate therapeutic skills and assessment techniques.
Designs, plans, implements effective patient education.
Develops, implements and evaluates patient care according to identified needs.
Collaborates with appropriate guardians and community agencies to insure effective service delivery.
Maintains open lines of communication, collaborates with healthcare team for patient outcome.
This position is Sign-on Bonus eligible for a bonus of $3,000 for Full Time positions.
Behavioral Health Utilization Review Specialist
By County of Santa Cruz At ,
Invites you to apply for:
BEHAVIORAL HEALTH UTILIZATION REVIEW SPECIALIST
To view full job announcement:
Behavioral Health, Utilization Management Review, Lcmhc/Lcsw/ Rn
By AmeriHealth Caritas At , Greensboro
Two or more years of behavioral health experience.
Strong problem solving skills and decision making skills.
This position requires residency in the state of North Carolina.
Current active professional licensure required in North Carolina: LCMHC, LCSW, RN
Proficiency in Microsoft Office, including Word, Excel and Outlook is required.
Ability to communicate in a positive/professional manner both orally and written.
Behavioral Health - Utilization/Case Manager
By Mercy At , Chesterfield, 63017
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)
Utilization Management - Behavioral Health Clinician
By Yamhill Community Care At , Mcminnville
Computer skills in word processing, database management, and spreadsheet desirable.
Knowledge in areas of: Medicare and Medicaid UM regulations, McKesson InterQual, and Denial Management.
Two (2) years of experience in Acute Clinical Care or Medical Management setting, adult and children.
Identifies members that are high risk or have conditions that may need case or disease management.
Enters and maintains pertinent clinical information in health management system.
Participates in utilization management committees and works on special projects related to utilization management as needed.
Utilization Management Clinical Coordinator - Substance Use And Behavioral Health - Remote For Colorado
By UnitedHealthcare At , Grand Junction, 81502
3+ years of utilization management experience
Provide management of behavioral health services, including crisis assessment and intervention
Administer benefits, review treatment plans, and coordinate transitions between various areas of care
Undergraduate degree or equivalent experience
1+ years of experience with MS Office, including Word, Excel, and Outlook
Experience in serving individuals with co-occurring disorders (both mental health and substance use disorders)
Team Coordinator, Behavioral Health Utilization Review
By Sentara Healthcare At , Norfolk, 23502
Provides educational services to the Utilization Management staff
Requires knowledge of managed care contracting, Medical Necessity, CMHRS services, DMAS protocols, clinical protocols and clinical review requirements
Minimum 1 year experience in Managed Care Setting (MCO)
First line supervisor in the Utilization Management Department
Provides a leadership role in ongoing utilization review competency assessment, needs identification and educational offerings
Requires knowledge of contractual, regulatory and compliance requirements for government payers, self funded and commercial payers
Behavioral Health Utilization Review Nurse- Hmhi
By University of Utah Health At , Salt Lake City, 84190, Ut
Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria.
One year Utilization Review or Case Management experience.
Knowledge / Skills / Abilities
Upload most recent updated resume with work history and experience, please include Month and Year in formatting.
Alerts and discusses with physician/provider and case manager/discharge planner when patient no longer meets medical necessity criteria for the inpatient stay.
Demonstrated team leadership, relationship building, critical analysis, and written and verbal communication skills.
Utilization Review Specialist - Behavioral Health
By Prestige Utilization Management & Billing Solutions At , Remote $35,000 - $40,000 a year
Excellent data entry skills and ability to navigate electronic systems applicable to job functions
Ensure all pre-certifications are completed for inpatient and outpatient services
Work with facilities to ensure documentation requirements are met
Interface with managed care organizations, external reviews, and other payers
2 or more years experience billing UR healthcare industry – in the mental health/addiction field.
Working knowledge of clinical case formulation for substance abuse/mental health treatment.
Outcomes Manager - Utilization Review - Behavioral Health (Remote)
By VIRTUA At , Marlton, 08053, Nj
Appropriate and complete documentation of clinical review and denial management in the case management documentation system and in the billing system.
Position Qualifications Required / Experience Required:
Manages the concurrent denial process by referring to appropriate resource for concurrent and retrospective appeal activity process.
Understands and applies applicable federal and state requirement.
Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity.
Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues.
Manager, Behavioral Health Utilization Management
By Point32Health At , Remote
5-8 years post-master’s direct clinical experience, including utilization management in behavioral health or managed care
Provide monthly Care Management report on team(s) performance, metrics, and goal achievement to the Director of Behavioral Health.
Demonstrated understanding and proficiency in the principles, concepts and techniques of managed care and utilization management.
Able to manage ambiguity and change, and lead a team’s effective management of shifting priorities, competing demands, and rapidly changing conditions.
5-8 years of supervisory experience preferred
Experience with Medicare and Medicaid
Home Health Utilization Management Nurse
By Humana At , , Tn
Previous experience in Case Management, Discharge Planning or Utilization Management
The Utilization Management Nurse 2/Home Health Utilization Management:
Clinical experience in Medicare Home Health (in the last 12 months)
Comprehensive knowledge of Microsoft Word, Outlook and Excel
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Previous Medicare/Medicaid Experience a plus
Associate Director Behavioral Utilization Management - Remote
By Optum At , Detroit, 48202, Mi
Provide direct oversight to a utilization management team, for employees at multiple locations across the country (remote)
3+ years of people management experience (managing direct reports, coaching, training, performance reviews, running team meetings, etc.)
Proven excellent communication, collaboration, team building and relationship management skills
Provides leadership to and is accountable for the performance of managers and/or senior level professional staff
5+ years of experience managing a clinical/operational unit in a broad range of settings
Experience interfacing with providers and solutioning gaps
Utilization Review Specialist - Behavioral Health
By WellBridge Fort Worth At , Fort Worth, 76132, Tx
Coordinate utilization management reviews for all assigned inpatient, partial hospitalization and intensive outpatient program patients.
Coordinates closely with Director of Utilization Management, Nursing and Clinical Services.
Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies.
Obtains authorizations for services, coordinates peer-to-peer reviews for assigned caseload.
Understands medical necessity criteria and facilitates accurate and timely documentation to support advocacy of services.
Master’s Degree in Social Work, Marriage and Family Therapy or Counseling from an accredited school or BSN, RN
Director National Quality Management-Behavioral Health Background Strongly Preferred!!
By Elevance Health At Montpelier, VT, United States
Proficient to advanced knowledge in Behavioral Health HEDIS interventions, member experience, member safety, and innovation implementation strongly preferred.
Extensive experience in behavioral health strongly preferred.
Experience leading a quality improvement team within an NCQA MBHO framework strongly preferred.
Extensive experience working in a highly matrixed environment strongly preferred.
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Produces QM documents, including tracking and updating Work Plan activity progress.
Director National Quality Management-Behavioral Health Background Strongly Preferred!!
By Elevance Health At Columbus, OH, United States
Proficient to advanced knowledge in Behavioral Health HEDIS interventions, member experience, member safety, and innovation implementation strongly preferred.
Extensive experience in behavioral health strongly preferred.
Experience leading a quality improvement team within an NCQA MBHO framework strongly preferred.
Extensive experience working in a highly matrixed environment strongly preferred.
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Produces QM documents, including tracking and updating Work Plan activity progress.
Director National Quality Management-Behavioral Health Background Strongly Preferred!!
By Elevance Health At Des Moines, IA, United States
Proficient to advanced knowledge in Behavioral Health HEDIS interventions, member experience, member safety, and innovation implementation strongly preferred.
Extensive experience in behavioral health strongly preferred.
Experience leading a quality improvement team within an NCQA MBHO framework strongly preferred.
Extensive experience working in a highly matrixed environment strongly preferred.
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Produces QM documents, including tracking and updating Work Plan activity progress.
Director National Quality Management-Behavioral Health Background Strongly Preferred!!
By Elevance Health At Tampa, FL, United States
Proficient to advanced knowledge in Behavioral Health HEDIS interventions, member experience, member safety, and innovation implementation strongly preferred.
Extensive experience in behavioral health strongly preferred.
Experience leading a quality improvement team within an NCQA MBHO framework strongly preferred.
Extensive experience working in a highly matrixed environment strongly preferred.
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Produces QM documents, including tracking and updating Work Plan activity progress.
Behavioral Health Coaching And Support Case Management Lead Analyst - Evernorth Health Services - Remote
By The Cigna Group At , Hartford, 06152, Ct $62,400 - $104,000 a year

This position supports the Intensive Behavioral Case Management program. The coaching & support care management programs help individuals make the behavioral changes and first steps necessary to ...