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Clinical Care Reviewer II - Behavioral Health
CareSource Management Services LLC
MCG Certification is required or must be obtained within six (6) months of hire required
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Discharge Planner
St. Clare's - Denville
Saint Clare's Health includes CMS 5-Star Rated hospitals and is an award-winning provider of safe, high quality, compassionate care, serving the communities of Morris, Warren and Sussex…
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Care Plan Reviewer - Clinical Case Manager Behavioral Health
Aetna Medicaid Administrators
Must reside in OH, KY, WV, or LA
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Director, Contractual Financial Oversight
Jobgether
…regulatory requirements. You will serve as a key financial reviewer for significant contracts and procurement initiatives, evaluating their financial implications, risks, and long-term…
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Psychologist Reviewer
The Elevance Health Companies, Inc.
Must possess an active unrestricted license to practice as Clinical/Counseling Psychologist
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Intake Specialist II
CareSource Management Services LLC
…authorization requests received via various methods into the Utilization Management department. The Intake Specialist role handles incoming requests from providers, assists with reviewing…
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RN Utilization Management Reviewer
Blue Cross and Blue Shield of Massachusetts, Inc.
The Clinical Utilization Reviewer is part of a highly dedicated and motivated team of professionals, including medical and behavioral health care managers, dieticians, pharmacist,…
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Medical Management Manager
Arizona Department of Administration
The Medical Services Manager oversees daily operations of the health and dental programs within the Department of Child Safety's (DCS) Comprehensive Health Plan (CHP). In this role, you'll…
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Associate Medical Director, Behavioral Health
Dane Street, LLC
We are seeking a Behavioral Health Associate Medical Director to provide part-time clinical leadership and subject matter expertise in support of the Group Health utilization review…
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Senior Pharmacist - Strategy (Hybrid)
Highmark Health
+ Quality Assurance & Review: Serve as a peer-reviewer of medication reviews, pharmacy utilization management policies, and other strategy deliverables, as applicable.
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After Hours Behavioral Health Clinical Care Utilization Management Reviewer
Amerihealth Caritas
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities · Must have ability to obtain additional licensure in OH, LA, NC, NH and DC within 12 months from date of hire
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Medicare Advantage Utilization Management Physician (Agency Temp, Part-time)
SHPCA SCAN Health Plan
Minimum of 2–3 years of utilization management, case management, or managed care experience, including medical necessity review and peer-to-peer clinical discussions in a health plan…
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Medicare Advantage Utilization Management Physician (SCAN Temp, Part-time)
SHPCA SCAN Health Plan
Minimum of 2–3 years of utilization management, case management, or managed care experience, including medical necessity review and peer-to-peer clinical discussions in a health plan…
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Discharge Planner - Utilization Management
Prime Healthcare
Responsible for the coordination of the various activities of the Case Management Department under the direction of the assigned Case Manager/Social Worker assist with development and…
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Discharge Planner
St. Francis Medical Center
…Cardiovascular, Surgical, Orthopedics, Obstetrics, Pediatrics, Behavioral Health, and Emergency and Trauma Care. In addition, the hospital offers a broad array of education and outreach…
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ASSISTANT CHIEF, CLINICAL SOCIAL WORK
County of Los Angeles
The Assistant Chief, Clinical Social Work for Los Angeles County Department of Health Services (DHS) is a senior management position responsible for helping coordinate clinical social work…
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Clinical Reviewer
Acentra Health, LLC
Acentra Health is looking for a Clinical Reviewer to join our growing team.
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Senior Pharmacist - Strategy
Highmark Inc
Quality Assurance & Review: Serve as a peer-reviewer of medication reviews, pharmacy utilization management policies, and other strategy deliverables, as applicable.
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Part time RN Senior Review Coordinator Behavioral Health/Psychiatric (Saturday's and Sunday's and Holidays)
Telligen
As a Senior Review Coordinator RN, you will primarily conduct utilization reviews for acute inpatient psychiatric services to determine medical necessity and appropriateness of care. This…
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Behavioral Health Nurse Navigator
The Health Plan of West Virginia Inc
The Behavioral Health Nurse Navigator strives to improve member health and assure optimal navigation of behavioral health and substance use disorder (SUD) services, including co-occurring…
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Pharmacist
Blue Cross and Blue Shield of Massachusetts, Inc.
The Clinical Pharmacist Reviewer reviews formulary exception, prior authorization and quantity limit exception requests from providers via phone and fax for the Retail Pharmacy, Medicare…
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Pharmacist
Blue Cross and Blue Shield of Massachusetts, Inc.
The Clinical Pharmacist Reviewer reviews formulary exception, prior authorization and quantity limit exception requests from providers via phone and fax for the Retail Pharmacy, Medicare…
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Manager BH Utilization Management and ABA Peer Reviewer
Healthfirst
…authorization, concurrent review, and retrospective cases related to Behavioral Health UM and ABA services; applying clinical expertise, evidence-based criteria, plan benefits, and…
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Clinical Reviewer
Acentra Health, LLC
This is a fully remote position where you must reside and work in the state of Arkansas
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