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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). The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed.
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Utilization Review Specialist/Behavioral Health Substance Abuse. Job Overview: The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies.
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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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Collaborate with other organizational departments responsible for functional aspects of the HIV Special Needs Plan, including, but not limited to Integrated Care Management, Behavioral Health, Managed Long-Term Care, Utilization Management, Quality Management, Credentialing, Regulatory Affairs, Compliance, Corporate Affairs, Provider Network Operations, Medicare Services, Information Systems, Finance, Claims, and Member Services and Eligibility.
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Active California Counseling License Required (e.g., LPCC, LCPC, LCMHC, LMHC, LCSW). This list may expand to include additional duties deemed necessary by management. Acentra seeks aUtilization Clinical Reviewer - LCSW/LMFT/LPCC/LCPC (Remote within California) to join our growing team.
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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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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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LMHC, EVP will join a team that offers leading Substance Abuse treatment including Detox, Residential, IOP/PHP, and First Responder services. Licensed Mental Health Counselor, LMHC or Licensed Clinical Social Worker, LCSW.
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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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Preferred:-Leadership experience in a utilization management clinical operations business inside a health plan or a UM/benefits management firm-Utilization management or clinical experience with post-acute care, especially home health and DME-Experience managing productivity with operational tools such as WFM software, Excel, Tableau, Smartsheet, dashboard and report-buildingFor candidates working in person or remotely in the below locations, the salary.
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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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The ideal candidate for the Program Director role at Outreach's Women's Residential program should possess an advanced degree and hold licensures such as LMSW, LCSW, LMHC, or higher, with a preference for individuals with 3-5 years of robust program management and supervisory experience in an OASAS funded facility.
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Notifies Utilization Review Supervisor, Case Management Director, Medical Director of Utilization Management and/or CMO as appropriate, of all unresolved utilization problems or issues.
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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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The Field Community Health Worker, (Care Management Support Professional 1), contributes to the administration of Care Management and Utilization Management. The Field Community Health Worker, (Care Management Support Professional 1), builds visibility and credibility of Humana's products and services throughout the community via chats, posts, and interactions.
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utilization management lmhc aftercare jobs Company: Metroplus Health Plan
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