- AmeriHealth Caritas (Palm Beach Gardens, FL)
- …all information necessary to perform a thorough medical necessity review . It is within Clinical Care Reviewer UM discretion to pend requests for ... ** Clinical Care Reviewer UM ** Location: Palm Beach Gardens, FL Primary Job Function: Medical Management ID**: 31413 Your career starts now. We are… more
- AmeriHealth Caritas (Orlando, FL)
- …where ACFC has a line of business within 3 months of employment. 5+ yrs clinical practice. UM / Care Coordination exp. preferred. Your career starts now. We ... **Medical Director, UM Review , Family Medicine** Location: Orlando,...throughout the provider network. + Overseeing the quality of clinical care for network and non-network providers.… more
- Centers Plan for Healthy Living (Margate, FL)
- UM Clinical Reviewer 5297 W...care managers and believe that coordinating high quality clinical and social services will result in better clinical ... healthy living. One of the fastest growing Managed Long-Term Care company in New York, Centers Plan For Healthy...Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team… more
- Kepro (Richmond, VA)
- …vital partner for health solutions in the public sector. Acentra seeks a Behavioral Health UM Clinical Reviewer (part-time) to join our growing team. Job ... Management Clinical Reviewer will use clinical expertise to review medical records against...against criteria to determine medical necessity and appropriateness of care ; determine if the medical record documentation supports the… more
- Queen's Health System (Kamuela, HI)
- RESPONSIBILITIES I. JOB SUMMARY/RESPONSIBILITIES: * Provides clinical consultation as a Registered Nurse (RN) with the Patient Care Team to facilitate ... care across the continuum for selected complex patients. * Partners with Patient Care Team; maintains accountability for the delivery of patient care and… more
- AmeriHealth Caritas (Palm Beach Gardens, FL)
- …perform a thorough medical necessity review . It is within the BH UM Reviewer 's discretion to retain requests for additional information and/or request ... **Behavioral Health UM Review ** Location: Palm Beach Gardens,...integrated care management as needed. The BH UM Reviewer will apply medical health benefit… more
- CVS Health (Pittsburgh, PA)
- … Clinical Operations, Clinical Account Management, Formulary Administration, and Clinical Affairs. The UM Clinical Development pharmacist may be ... more personal, convenient and affordable. Position Summary The Utilization Management ( UM ) clinical development pharmacist will develop clinically and ethically… more
- Guthrie (Sayre, PA)
- Position Summary: The Utilization Management ( UM ) Reviewer , in collaboration with other internal and external offices, payors, and providers and staff, is ... processes and requirements for prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures authorization as… more
- Cleveland Clinic (Stuart, FL)
- …chart review and clinical systems review to measure clinical performance and UM issues that affect reimbursement for the patient's hospital stay ... a home away from home. As a Utilization Management ( UM ) RN Reviewer , you will work under...your responsibilities include medical record review , providing clinical information to the payer, UM data… more
- Molina Healthcare (Dallas, TX)
- **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management ( UM ), Case Management (CM), ... or related field. **Required Experience** + Minimum two years UM , CM, MAT, HM, DM, and/or managed care...medical or behavioral health settings. + Two years of clinical auditing/ review experience. To all current Molina… more
- AmeriHealth Caritas (Palm Beach Gardens, FL)
- **Supervisor UM Review ** Location: Palm Beach Gardens, FL Primary Job Function: Medical Management ID**: 31403 Your career starts now. We are looking for the ... this position is responsible for providing daily oversight of UM Nurses, UM Technicians and staff members...setting. + Minimum 3 years of experience in managed care utilization review . + Proficiency with Microsoft… more
- Universal Health Services (Memphis, TN)
- …such as alcoholism, drug addiction and substance abuse. Job Description The UM Coordinator possesses knowledge of psychiatric clinical diagnosis and the ... ability to articulate those indicators professionally. The UM Coordinator evaluates patient medical records to determine severity...advocates for patient length of stay and level of care . Oversees utilization review activities with other… more
- Sharp HealthCare (San Diego, CA)
- …compliance with all local, state and federal regulations governing utilization review activities and/or care management. Expected outcomes include meeting ... care nursing experience + 2 Years recent pertinent clinical experience as defined by the CBA + California...individual competency and skillset in the area of utilization review , integrated care management and transition planning.Seeks… more
- Sharp HealthCare (San Diego, CA)
- …the System Integrated Care Management (ICM) team the Utilization Manager ( UM ) II position supports utilization review functions to ensure appropriate patient ... with all local, state and federal regulations governing utilization review activities and/or care management. Expected outcomes...care nursing experience. + 2 Years recent pertinent clinical experience as defined by the CBA. + California… more
- University of Miami (Miami, FL)
- …(all Hospitals and clinics) where patient care is provided, or work in patient care or clinical care areas, to have an annual influenza vaccination. ... to supervisors for formulating and revising protocols, policies, and standards of care based on clinical experience and exposure. Education Requirements… more
- University of Miami (Miami, FL)
- …(all Hospitals and clinics) where patient care is provided, or work in patient care or clinical care areas, to have an annual influenza vaccination. ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Life Alliance… more
- Sharp HealthCare (San Diego, CA)
- …or visit to the ER.Attends and participates in SNF rounds, and/or patient care conferences as appropriate. Attends clinical in-services or required operational/ ... Department regarding any quality of service or quality of care issues encountered in the course of review...Knowledge of available community resources and current standards of clinical practice. + Knowledge of managed care ,… more
- Elevance Health (Louisville, KY)
- … clinical consultation and serve as clinical /strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a ... changes in healthcare. + Leads, develops, directs, and implements clinical and non- clinical activities that impact health care quality cost and outcomes. +… more
- Elevance Health (Atlanta, GA)
- … clinical consultation and serve as clinical /strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a ... changes in healthcare. + Leads, develops, directs, and implements clinical and non- clinical activities that impact health care quality cost and outcomes. +… more
- CVS Health (Topeka, KS)
- …Monday through Friday, 8am to 5pm upon hire. Preferred Qualifications + ER and/or ICU clinical experience + 1+ year(s) Managed Care (MCO) experience + 1+ year(s) ... of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at… more