The RN Case Manager is responsible for telephonically and/or face-to-face assessing, planning, implementing, and coordinating all case management activities with members to evaluate medical needs and facilitate overall wellness. This involves developing proactive courses of action to address issues, utilizing clinical tools to evaluate needs and benefits, and applying clinical judgment to reduce risk factors.

The Behavioral Health UM Clinician is responsible for clinically reviewing behavioral health prior authorized services for assigned members, utilizing clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. This role involves assessing the appropriateness of treatment plans, applying clinical criteria to render coverage determinations, and coordinating with providers to facilitate optimal care and discharge planning.

High Acuity Behavior Specialist– ABA Centers Remote Who We Are We are the nation’s fastest-growing provider of autism care, delivering high-quality Applied Behavior Analysis (ABA) therapy across a rapidly expanding footprint. Since our foundin...

The Utilization Management Manager plays a vital role in ensuring patients have timely access to care by managing both front-end prior authorizations and in-house concurrent review authorizations. This position blends strong relationship-building skills with clinical knowledge to...