- Kepro (Richmond, VA)
- …a vital partner for health solutions in the public sector. Acentra seeks a Behavioral Health UM Clinical Reviewer RN to join our growing team. Job Summary: ... Our Clinical Reviewer RN will use clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements,… more
- Centers Plan for Healthy Living (Margate, FL)
- UM Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #664 Monday, April 29, 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
- CVS Health (Pittsburgh, PA)
- … Clinical Operations, Clinical Account Management, Formulary Administration, and Clinical Affairs. The UM Clinical Development pharmacist may be ... more personal, convenient and affordable. Position Summary The Utilization Management ( UM ) clinical development pharmacist will develop clinically and ethically… more
- Healthfirst (NY)
- …necessary 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 the… more
- Corewell Health (Grand Rapids, MI)
- …and meet department/organizational goals and objectives. + Plan and direct all Quality, UM and Clinical regulatory functions of the Behavioral Health department ... and mentoring to direct reports including direct oversight of quality review and clinical operations, as well as routine audits of staff performance related… 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
- Universal Health Services (Memphis, TN)
- …such as alcoholism, drug addiction and substance abuse. Job Description The UM Coordinator possesses knowledge of psychiatric clinical diagnosis and the ... ability to articulate those indicators professionally. The UM Coordinator evaluates patient medical records to determine severity of patient's illness and… more
- Humana (Topeka, KS)
- …works on semi-routine assignments. **Achieve your best at Humana. Join Us!** The UM Administration Coordinator 2 provides non- clinical support for the policies ... a part of our caring community and help us put health first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM … 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
- Elevance Health (Jacksonville, FL)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive… 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 ... companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive… 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 (Seven Fields, PA)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... outpatient professional treatment health benefits through telephonic or written review . How you will make an impact: + Uses...an impact: + Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access… 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
- Guthrie (Sayre, PA)
- Position Summary: The Utilization Management ( UM ) Reviewer , in collaboration with other internal and external offices, payors, and providers and staff, is ... or service for hospital inpatient admissions and short procedures by translating clinical information to UM requirements (using identified criteria). a)… 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
- Elevance Health (Las Vegas, NV)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... **Carelon Behavioral Health** , formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive… more
- Elevance Health (Latham, NY)
- …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 . Subject matter expert in targeted clinical areas of… more
- Elevance Health (Beaverton, OR)
- …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