- CVS Health (OK)
- …needs LCSW, LCPC, RN with experience in psychiatric setting required. Utilizes clinical skills to coordinate, document and communicate all aspects of the ... is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon… more
- CVS Health (OH)
- …it all with heart, each and every day. **Position Summary** This Clinical Consultant position is with Aetna's Utilization Management ( UM ) team and is a ... on business needs including occasional rotating weekend and holiday schedules. Utilizes clinical skills to coordinate, document and communicate all aspects of the… more
- OhioHealth (Columbus, OH)
- …work in high stress situations. **Responsibilities And Duties:** 30% Clinical Assessment Conducts patient/family/significant other interviews, chart reviews, and ... biopsychosocial functioning. Through individual, family, or group modalities, employs clinical intervention skills including, but not limited to, treatment planning;… more
- OhioHealth (Columbus, OH)
- …decisions and end-of-life issues. **Responsibilities And Duties:** 30% Clinical Assessment Conducts patient/family/significant other interviews, chart reviews, and ... biopsychosocial functioning. Through individual, family, or group modalities, employs clinical intervention skills including, but not limited to, treatment planning;… more
- OhioHealth (Cambridge, OH)
- …work in high stress situations. **Responsibilities And Duties:** 30% Clinical Assessment: Conducts patient/family/significant other interviews, chart reviews, and ... biopsychosocial functioning. Through individual, family, or group modalities, employs clinical intervention skills including, but not limited to, treatment planning;… more
- CVS Health (AZ)
- …the lives of patients facing complex medical journeys. As a Utilization Management ( UM ) Nurse Consultant specializing in Oncology and Transplant, you'll play a ... in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position offers… more
- CVS Health (Workman, MN)
- …healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team. In this role, you'll be at ... the forefront of clinical decision-making, applying your expertise in Behavioral Health to...+ Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM specialty teams… more
- CVS Health (VA)
- …environment. Through the use of clinical tools and information/data review, the UM Nurse Consultant reviews services to assure medical necessity, applies ... (UMNC) position is 100% remote. As a Utilization Nurse Consultant , you will utilize clinical skills to coordinate, document and communicate all aspects of the… more
- CVS Health (OH)
- …promote high-quality healthcare for members. We are seeking a dedicated Utilization Management ( UM ) Nurse to join our remote team. **Position Summary** The Team Lead ... projects. Acting as the first point of contact for clinical issues, the Team Lead provides guidance and support...a managed care setting). + Ability to provide on-call UM coverage for nights and weekends on a rotational… more
- US Tech Solutions (RI)
- **Job Description:** + Responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets data obtained from ... clinical records or systems to apply appropriate ...MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE… more
- CVS Health (MI)
- …and work schedule will include weekends, holidays and evening hours._ Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, ... to facilitate appropriate healthcare services/benefits for members. + Gathers clinical information and applies the appropriate clinical criteria/guideline,… more
- CVS Health (OH)
- …and Duals Program and is going to be auditing against the use of clinical criteria, policy procedures, and for compliance purposes. Schedule is Monday - Friday ... 8:00am - 5:00pm. Will have to maintain clinical review skills through the annual use of IRR....work with leadership for continual process improvement within Duals UM Program. **Required Qualifications** + RN with current unrestricted… more
- Omnicell (Fort Worth, TX)
- …der Omnicell-Losungen. Diese Position vereint die Aufgaben eines ** Clinical Solutions Consultants, Implementierungsberaters und Projektmanagers** , um ... ongoing support of Omnicell's solutions. This role combines the responsibilities of a Clinical Solutions Consultant & Implementation Consultant , to provide a… more
- Excellus BlueCross BlueShield (Rochester, NY)
- … appeal case reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on ARD cases, ... at first level, appeal and inquiries. + Conducts peer-to-peer clinical reviews with attending physicians or other providers to...in person meetings. + Serves as a resource and consultant to other areas of the company. + May… more
- University of Michigan (Ann Arbor, MI)
- …You will collaborate with Taubman Health Sciences Library informationists and Librarians at UM -Dearborn and UM -Flint to serve the data needs of our Health ... and potential application in different research settings to serve as a consultant for faculty and students in the Health Sciences. Consultation activities will… more
- Sutter Health (Santa Rosa, CA)
- …documentation of regulatory compliance and accurate coding. The Physician Advisor (PA) conducts clinical reviews on cases referred by UM /CM staff and or other ... medical staff, including house staff, and all utilization management ( UM ) personnel, Care Management (CM) personnel to develop and...and alternative levels of care. The PA acts as consultant to and resource for attending physicians regarding their… more
- Sutter Health (Santa Rosa, CA)
- …documentation of regulatory compliance and accurate coding. The Physician Advisor (PA) conducts clinical reviews on cases referred by UM /CM staff and or other ... medical staff, including house staff, and all utilization management ( UM ) personnel, Care Management (CM) personnel to develop and...and alternative levels of care. The PA acts as consultant to and resource for attending physicians regarding their… more
- Sutter Health (Emeryville, CA)
- …documentation of regulatory compliance and accurate coding. The Physician Advisor (PA) conducts clinical reviews on cases referred by UM /CM staff and or other ... medical staff, including house staff, and all utilization management ( UM ) personnel, Care Management (CM) personnel to develop and...and alternative levels of care. The PA acts as consultant to and resource for attending physicians regarding their… more
- University of Miami (Miami, FL)
- …to ensure efforts are driving value.CORE JOB FUNCTIONS1. Acts as a strategic consultant /advisor the broader UM /UHealth enterprise on high priority projects and ... and drives complex, critical business initiatives by directly partnering with clinical , academic, and administrative leaders across the organization. The incumbent… more
- Truman Medical Centers (Kansas City, MO)
- …best practices, regulatory standards, and financial goals. + Serve as an internal consultant to clinical staff, providing guidance on utilization practices, ... - 3:30PM **Hours Per Week** 4 **Job Description** **Utilization Management Nurse ( UM RN)** _Optimize Care. Improve Outcomes. Elevate the Patient Experience._ Are you… more