- Prime Healthcare (Ontario, CA)
- …or another relevant field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health Plan + An ... join our corporate team! Responsibilities The Corporate Director of Clinical Utilization Management (UM) provides... Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee… more
- US Tech Solutions (Canton, MA)
- …of clinical decision making and support needed to perform utilization management , medical necessity determinations and benefit determinations using ... remote, but Massachusetts RN license required.** **Job Summary The Clinical Reviewer is a licensed professional -a...unrestricted Massachusetts license required + Minimum of five years clinical experience in utilization management ,… more
- CVS Health (Charleston, WV)
- …more compassionate. And we do it all with heart, each and every day. ** Utilization Management Clinical Consultant** **Remote - West Virginia** Schedule is ... RN with experience in psychiatric setting required Preferred Qualifications: + Managed care/ utilization review experience preferred + Experience in a behavioral… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in department) - Provides guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as resource to ... RN license required. Bachelors degree preferred. + Minimum of three years of clinical experience required. Utilization Management experience preferred. +… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- AmeriHealth Caritas (Newark, DE)
- …**Responsibilities:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will...document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… more
- Magellan Health Services (Baton Rouge, LA)
- … Reviewer III (ECSS), Remote in LA Grade 26 Work Experience - Required Clinical , Utilization Management Work Experience - Preferred Education - Required ... family engagement, and system-level collaboration with other child-serving agencies. The Clinical Reviewer will support the implementation and ongoing oversight… more
- AmeriHealth Caritas (Washington, DC)
- **Role Overview** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and ... overtime, and weekends based on business needs **Responsibilities** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Magellan Health Services (Albuquerque, NM)
- … III, Behavioral Health - Albuquerque, NM Grade 26 Work Experience - Required Clinical , Utilization Management Work Experience - Preferred Education - ... other clinical staff. + Provides training, interpretation and support for QI Clinical Reviewer staff. + Audits and validates internal audit results and/or… more
- CVS Health (Columbus, OH)
- …and trainings to New Albany Office in OH. **Preferred Qualifications** + Managed care/ utilization review experience preferred + Experience in a behavioral health ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and is knowledgeable… more
- CVS Health (Baton Rouge, LA)
- …rotating weekend and holiday schedules. Preferred Qualifications: + Managed care/ utilization review experience preferred + Experience in a behavioral ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and is knowledgeable… more
- CVS Health (Phoenix, AZ)
- …the lives of children and adolescents? Join Mercy Care as a Behavioral Health Utilization Management Clinician and become part of a mission-driven team that's ... Care is the place for you. **Key Responsibilities** + Review clinical information and apply medical necessity...(DCS). + Knowledge of Behavioral Health Outpatient Services. + Utilization Management (UM) Experience. **Education** + Master's… more
- Veterans Affairs, Veterans Health Administration (Cheyenne, WY)
- …possessing intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical ... position responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice setting.… more
- UPMC (Pittsburgh, PA)
- …1 year of health insurance experience required. + 1 year of experience in clinical , utilization management , home care, discharge planning, and/or case ... interdisciplinary team summarizing clinical and social history, healthcare resource utilization , case management interventions. Update the plan of care… more
- UPMC (Pittsburgh, PA)
- …1 year of health insurance experience preferred. + 1 year of experience in clinical , utilization management , home care, discharge planning, and/or case ... care, addresses barriers to care, and supports the member's self- management of chronic illness based on clinical ...member care. Conducts comprehensive face-to-face assessments that include a clinical assessment and treatment, a review of… more
- UPMC (Pittsburgh, PA)
- …1 year of health insurance experience preferred. + 1 year of experience in clinical , utilization management , home care, discharge planning, and/or case ... care, addresses barriers to care, and supports the member's self- management of chronic illness based on clinical ...member care. Conducts comprehensive face-to-face assessments that include a clinical assessment and treatment, a review of… more
- UPMC (Pittsburgh, PA)
- The Regional Medical Director, CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. ... care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote...administration and clinical teams. + Experience in utilization management and care coordination. + In-depth… more
- Actalent (Sunrise, FL)
- …as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + InterQual + Milliman Commercial Guidelines + ... care setting highly desirable. + Four years of related clinical experience in a healthcare field; or equivalent combination...+ Valid Florida Driver's License. + Knowledge of case management and utilization review concepts,… more
- Actalent (Sunrise, FL)
- …as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + Interqual + Milliman Commercial Guidelines + ... an acute care setting. + Four years of related clinical experience in a healthcare field or equivalent combination...+ Valid Florida Driver's License. + Knowledge of case management and utilization review concepts,… more