- Centers Plan for Healthy Living (Margate, FL)
- UM Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #664 Monday, September 9, 2024 Centers Plan for Healthy Living's goal is to create the ... applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help… more
- Molina Healthcare (Long Beach, CA)
- …Care setting + 5+ years of clinical correspondence processing and quality review experience + **Bilingual- Spanish** + ** UM experience** To all current ... **Job Description** **Job Summary** The Clinical Correspondence Review Nurse is responsible...are seeking a candidate with a RN license and UM experience. Prior Case Management experience highly preferred. Strong… more
- Integra Partners (Troy, MI)
- …and clinical processes + Develop and deliver comprehensive training programs for UM clinical staff on: + Writing clear and concise clinical ... educator to join our Operations Training & Development team as an Operations UM Training Specialist, specializing in Utilization Management ( UM ) processes. The… more
- Kepro (AR)
- …deliverables and provide day-to-day oversight to manage multiple areas of the UM program and oversee the implementation of clinical contract requirements ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… 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
- 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 (Coral Gables, 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) . The University of… more
- Elevance Health (Olathe, KS)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... Kansas PulsePoint offices. Please note: The BH Care Manager ( UM ) job progression is primarily a provider facing role...member facing activities such as collecting information and using clinical knowledge and expertise to ensure our members are… more
- Commonwealth Care Alliance (Boston, MA)
- …the provisions of CCA's benefits plan. The Utilization Management ( UM ) Reviewer is responsible for day-to-day timely clinical and service authorization ... **What You'll Be Doing:** **Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a… more
- Magellan Health Services (Honolulu, HI)
- …directly influence quality of care. General Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work Experience - Required ... Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse… more
- Fallon Health (Worcester, MA)
- …maintenance of existing letters and rollout of new letters. Collaborates closely with the UM Clinical and Prior Auth staff to ensure appropriate and applicable ... nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences,...This position serves as the subject matter expert on UM letters, and works in conjunction with other FH… 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 (Cary, 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
- University of Miami (Coral Gables, FL)
- …anesthetist (CRNA) faculty for full- time positions at the Assistant/Associate/Full Professor of Clinical rank. UM is one of the top research universities and ... 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) . NURSE ANESTHESIA FULL… more
- Point32Health (MA)
- …provides recommendations to improve outcomes of assigned services such as CM and UM (Utilization Management). The Clinical Program Manager works directly and ... are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Program Manager is a Registered Nurse who performs program oversight… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 ... to achieve that purpose. Job Summary The Utilization Management Clinical Quality Nurse Reviewer RN II, under...to submit to the department's Quality Assurance Team and UM Management. Duties Facilitates the development, review ,… more
- Point32Health (MA)
- …who we are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Reviewer is a licensed Registered Nurse that is expected ... clinically complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the...functions as a member of the Precert / Outpatient UM team and works under the general direction of… more
- Kepro (ND)
- …growing team. Job Summary: Our Nurse Clinical Reviewer will use clinical expertise for the review of medical records against appropriate criteria in ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...compact state license. + 1+ years of Utilization experience Review ( UM ) and/or Prior Authorization or related… more
- University of Maryland, Baltimore (Baltimore, MD)
- …patient care decision making * In collaboration with Oncology Practice Leadership and UM SJMC Leadership teams, develop annual clinical operational goals and ... interventions in alignment with Oncology Clinical Service Line roadmap. * Attend UM ...accord with institutional research processes * Conducts physician peer review activities as requested by medical staff office *… more