- TalentBurst, Inc (Irving, TX)
- …- 40 hours/week Location - Irving TX 75039 JOB SUMMARY The RN Utilization Review II is responsible for determining the clinical appropriateness of care provided ... TalentBurst, Inc is seeking a travel nurse RN Utilization Review for a travel nursing job in Irving, Texas.Job...for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and… more
- Centers Plan for Healthy Living (Margate, FL)
- UM Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #664 Monday, June 3, 2024 Centers Plan for Healthy Living's goal is to create the ultimate ... applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help… 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 experience....medical or behavioral health settings. + Two years of clinical auditing/ review experience. To all current Molina… more
- AmeriHealth Caritas (Orlando, FL)
- **Medical Director, UM Review , Family Medicine** Location: Orlando, FL Primary Job Function: Medical Management ID**: 31409 **Job Brief** Must be able to ... 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 are… more
- Healthfirst (NY)
- …approvals from key governance committee members. + Review the appropriate UM or related clinical and medical policies, job aids/procedures, and ... spearhead the policy work that will inform Medical and Clinical strategy + Perform editorial formatting and review...ad hoc medical condition research per Medical Director and/or UM Clinical Director requests. + Collaborate with… more
- The Cigna Group (Franklin, TN)
- … clinical compliance within the UM programs, including matters concerning clinical policy, quality management (QM), program development, review of UM ... **Responsibilities and Essential Functions** + Responsible for development of clinical policy, clinical review decisions,...Client teams for clinical matters related to UM client contracts + Review official program… 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 coordination ... community setting, as assigned. * Coordinates, implements and facilitates key clinical performance improvement efforts including, but not limited to: disease… more
- University of Miami (Miami, FL)
- …and Clinical Information Services (LRCIS) The University of Miami ( UM ) Libraries seeks nominations and applications for a creative, innovative professional to ... and Information Services Librarian of the Department of Learning, Research, and Clinical Information Services (LRCIS) on UM 's Medical Campus. Under the… more
- University of Miami (Coral Gables, FL)
- …sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Associate Dean for Graduate Clinical Programs The University of Miami ( UM ... eligible for appointment at the rank of Associate Professor or Professor of Clinical . UM is one of the top research universities and academic medical centers in… more
- University of Miami (Miami, FL)
- …serves the Miller School of Medicine's educational and biomedical research programs, and UM 's clinical enterprise, UHealth. Library services are also provided to ... 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) . Collection Development, Assessment,… more
- Apex Health Solutions (Houston, TX)
- …Solutions' members for the utilization review (UR) of healthcare services. The UM Reviewer will be responsible for complying with utilization review ... Summary: The UM Reviewer serves as a contact...review /precertification requirements. *Collects and/or documents all required enrollee clinical and co-morbidity information during the pre-authorization process to… more
- The Arora Group (Bethesda, MD)
- …Care Manager Certified (CMC) + Experience: + Referral Management/Utilization Management (RM/ UM ) experience. + Clinical subspecialty experience in Behavioral ... and cost-effective outcomes, across the continuum of care. + Serves as a clinical case manager and patient advocate, providing advanced practice clinical ,… 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
- Guthrie (Binghamton, NY)
- …- Utilization Management (Days) Full Time Position Summary: The Utilization Management ( UM ) Reviewer , in collaboration with other internal and external offices, ... or service for hospital inpatient admissions and short procedures by translating clinical information to UM requirements (using identified criteria). a)… more
- Elevance Health (Winston Salem, NC)
- …medically necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer ... companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive… more
- Baylor Scott & White Health (Temple, TX)
- …Is accountable to provide professional leadership and direction in the utilization/cost management ( UM ) and clinical quality improvement (QI) of the Health Plan, ... UM and QI goals. Works collaboratively as a clinical resource to other plan functions that interface with...utilization/cost and quality outcomes. + Participate in the retrospective review and research of Health Plan performance from summary… more
- Elevance Health (Houston, TX)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... facility-based and outpatient professional treatment health benefits through telephonic or written review .** **Primary duties may include but are not limited to:** +… more
- Elevance Health (Woodland Hills, CA)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... facility-based and outpatient professional treatment health benefits through telephonic or written review .** **Primary duties may include but are not limited to:** +… more
- Elevance Health (Rocky Hill, CT)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... and outpatient professional treatment health benefits through telephonic or written review .** **How you will make an impact:** + Uses appropriate screening… more
- YesCare Corp (Hagerstown, MD)
- …Adherence to UM programs specific to the contract requirements and corporate's UM and clinical policies and procedures. + Attend facilities' meetings as ... + Utilization Management experience + Must have minimum of 5 years clinical experience in Family Practice, Emergency Medicine, Internal Medicine, Public Health, or… more
