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By leading market level projects and strategies for provider engagement, this position will drive optimal performance on quality, risk adjustment, utilization management, financial performance, and membership growth.
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Fairmount Behavioral Health System is seeking a Utilization Management (UM) Coordinator to reviews patient medical records to determine severity of patient's illness and the appropriateness of level of care.
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Areas of oversight for this position include, but are not limited to, case management, quality management, utilization management (UM), and grievance and appeals and committee participation.
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Oversee all MCO functional areas, including quality management, utilization management, network development and management, provider relations, member outreach and education, member services, contract compliance, and reporting.
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Three to Five (5) years experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, or Utilization Review Coordinator). Utilization Review Specialist/Behavioral Health Substance Abuse.
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4-5 years of utilization management, care management, discharge planning, or value-based care experience. The Manager of Care Management at Legacy Community Health will lead a team of Nurses, Social Workers, Behavioral Health Professionals, and non-licensed staff in the delivery of care management services to Legacy patients.
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Community Health Worker collaborate with Case Managers, (CMs), and Utilization Management, (UM), Nurses to address co-occurring physical health, behavioral health, and social factors affecting members.
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Knowledge and experience with SAMSHA regulations, DPH, Joint Commission, Utilization management Detoxification requirements, Core measures, and psychiatric experience with the adult, child and adolescent and TBI and Rehab populations.
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They will collaborate closely with the Associate VP, Clinical Services, the Director, BH & Addictions and Recovery Treatment Services (ARTS), and the Chief Medical Officer (CMO) to integrate the day-to-day administration and strategic management of behavioral and physical health services, including Care Management (CM), Utilization Management (UM), Quality Improvement, and value-based payment programs.
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Utilization of population health management tool (I-Care) and electronic health record (RPMS) to collect and manage data for the patient registries. Summary: The Public Health Case Manager functions as an integral member of the medical and behavioral health departments with the aim of improving self-management and clinical outcomes for patients of San Diego American Indian Health Center.
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Also responsible for marketing and enrollment growth, utilization management, network development, and all aspects of financial performance. cardiology, bariatric surgery, oncology, endocrinology, primary care, allergy, immunology & rheumatology, pulmonology, elderly services, infectious diseases, hematology, women's health, nursing, gynecology, labor and delivery, neurology, rehabilitation, mental health servies, behavioral health services, neurosurgery, physical therapy, and orthopaedics.
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Knowledge of Behavioral Health managed care practice, including utilization management, population health improvement, guideline development, disease management and cost effectiveness evaluation.
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Oversees, monitors, and assists with the management of psychopharmacology pharmacy benefits manager (PBM) activities, including the establishment of prior authorization, clinical appropriateness of use, and step therapy requirements for the use of stimulants and antipsychotics for all Members; consultations and clinical guidance for contracted primary care Providers (PCPs) treating behavioral health‐related concerns not requiring referral to behavioral health specialists.
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Director Care Coordination- Major Responsibilities Criteria A: Establishes and coordinates communication with all Utilization Regulatory Agencies i.e. Qualidigm, NGS, etc., State and Third Party Payers to address Utilization Management Issues and Denials.
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The Utilization Review Nurse provides clinical review for different healthcare services requiring authorization- including acute inpatient, skilled nursing facility, acute rehab, home nursing as well as others.
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utilization management behavioral jobs Company: Metroplus Health Plan
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