- Molina Healthcare (Springfield, MA)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... JOB DESCRIPTION Job Summary The Care Review Clinician, IP Provides support...with a MA RN licensure. Candidates with UM Medical Review background and experience using… more
- Highmark Health (Hartford, CT)
- …in a clinical setting **Preferred** + Experience in UM /CM/QA/Managed Care **LICENSES AND CERTIFICATIONS** **Required** + Current RN state licensure ... :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services, application of… more
- Evolent (Hartford, CT)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... issues to UM Leadership. + Appropriately identifies potential cases for Care Management programs + Collaborates with physicians and other providers to facilitate… more
- Elevance Health (Rocky Hill, CT)
- …disorder facility-based and outpatient professional treatment health benefits through telephonic or written review . The BH Care Manager ( UM ) job progression ... **JR168947 Behavioral Health Care Manager II** Responsible for managing psychiatric and...behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to… more
- Highmark Health (Hartford, CT)
- …and/or triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established ... in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced...in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or… more
- Elevance Health (Rocky Hill, CT)
- **Behavioral Health Care Manager II** A proud member of the Elevance Health family of companies, **Carelon Behavioral Health** , offers superior clinical mental ... for autism and depression, and insightful analytics to improve the delivery of care . **Virtual** - This role enables associates to work virtually full-time, with the… more