• Charlotte Behavioral Health Care (Punta Gorda, FL)
    Job Description Unique full time oppty w/benefits to join the CBHC team! UM Specialist - Full Time Crisis Services - Punta Gorda Position Summary: This motivated ... insurance claims. Minimum Requirements: 1. Bachelor's degree in behavioral health field. 2 . Must have significant knowledge of psychiatric and substance use disorder… more
    ZipRecruiter (04/14/19)
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  • Hiring Companies (Woburn, MA)
    …Job Family Clinical, Unlicensed Job Brief We are currently seeking a dynamic UM Clinical Intake Coordinator to join our growing Utilization Management team in ... About the Position: We are currently seeking a dynamic UM Clinical Intake Coordinator to join our growing Utilization...of contact for Providers and therefore must have a professional demeanor over the phone and possess exceptional customer… more
    NationJob (04/02/19)
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  • LifeStream Behavioral Center (Leesburg, FL)
    …an analytical spirit and be competent in developing, tracking, and trending UM metrics. Highly knowledgeable of medical terminology, ICD-10 and CPT coding, DSM ... 5, and willingness to expand knowledge of the UM field as it evolves. Has a high level...performance feedback to all staff, leaders, and providers Ensures compliance for various accrediting bodies and government agencies and… more
    ZipRecruiter (04/16/19)
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  • MedStar Family Choice (Baltimore, MD)
    …years case management experience; 5 years diverse clinical experience; 2 years supervisory experience required. License/Certification/Registration Valid RN license ... personal and educational goals and objectives to enhance their professional development. Develops and implements education programs to coordinate...goals and assists with the development of the annual UM plan and UM appraisal. Assists with… more
    Neuvoo (04/16/19)
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  • Affinity Health Plan (Bronx, NY)
    …and works with network clinicians to pursue subsequent quality improvement efforts. 2 . Provides professional advice, guidance and support to other operational, ... competence and soundness of Affinity’s service delivery program by providing professional expertise (ie, guidance, advice, decisions, actions and judgments) to all… more
    ZipRecruiter (03/29/19)
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  • Inpatient Case Manager (San Jose, CA)
    …goals and objectives. The Ideal candidate would be a dedicated, organized, professional Registered Nurse with an experience. The Inpatient Case Manager: Conducts ... Case Managers to ensure comprehensive and coordinated care. Work closely with UM department, Quality Management, Provider Services, Contracting, and Claims staff to… more
    ZipRecruiter (04/17/19)
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  • The Center for Health Care Services (San Antonio, TX)
    …monitor service delivery and outcomes, provide provider training on the UM process. TASKS Provide diagnostic assessments, treatment plans and other clinical ... REQUIREMENTS Current license in the State of Texas as a Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family… more
    ZipRecruiter (03/31/19)
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  • Corizon Health, Inc. (Jefferson City, MO)
    …client to implement appropriate interventions. Develops and leads a team of physicians in UM decision making, compliance with clinical quality and UM ... Medicine, Emergency Medicine, or Obstetrics and Gynecology) Minimum of two ( 2 ) years clinical experience required. Preferred experience includes: Managed care… more
    TheJobNetwork (04/01/19)
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  • Luke & Associates (Dayton, OH)
    …requirement, if applicable. Experience: Six years of clinical nursing experience with 2 year of Utilization Review/Management is required for a Bachelor of Science ... peer review as assigned. Educates Patient Centered Medical Home (PCMH) staff on UM role. Assists with PCMH team notification of patients admitted inpatient to… more
    ZipRecruiter (03/22/19)
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  • The University of Mississippi (University, MS)
    …reviewing the work of other personnel. Examples of Work Performed Performs professional and complex clerical accounting tasks in maintaining financial records and ... upon university policy. Ensures all assigned tasks are in compliance with department and University rules and regulations. Makes...High School Diploma or equivalent (GED). AND Experience: Two ( 2 ) years of experience related to the above described… more
    University of Mississippi (04/18/19)
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  • Luke & Associates (Dayton, OH)
    …direct patient contact, family/caregiver, and other relevant sources such as professional and non- professional caregivers. Reviews the patient’s medical record ... and guidelines; established principles, ethics and standards of practice of professional nursing; the Case Management Society of America (CMSA); American… more
    ZipRecruiter (03/25/19)
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  • Compliance Professional 2

    Humana (North Miami, FL)
    Description The Compliance ( UM ) Professional 2 conducts and summarizes compliance audits. The Compliance ( UM ) Professional 2 work ... week. Occasional overtime as needed based on the needs of the business. The Compliance ( UM ) Professional 2 collects and analyzes data daily, weekly,… more
    Humana (03/21/19)
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  • UM Pre- Service LVN

    Dignity Health (Bakersfield, CA)
    …+ **FLSA Status:** Non-Exempt + **Remote Worker:** Non-eligible **Responsibilities** The UM Pre- Service LVN uses clinical judgement in providing utilization ... daily basis working oldest referrals first to assure 98% compliance with ICE timeframes. + Follows job work aide...LVN performs Inter-Rater Reliability audits as directed by the UM Supervisor or UM Manager. + The… more
    Dignity Health (02/02/19)
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  • Nurse Medical Mgmt I (Inpatient UM ) - PS…

    Anthem, Inc (Eagan, MN)
    Nurse Medical Mgmt I (Inpatient UM ) - PS 19516 (Eagan MN ONLY; not remote) **Location:** **Eagan, Minnesota, United States** **New** **Field:** Medical **Requisition ... #:** PS19516 **Post Date:** 2 days ago _Your Talent. Our Vision._ **At Anthem,...planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility,… more
    Anthem, Inc (04/17/19)
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  • Manager

    UM FDSP Associates, PA (Baltimore, MD)
    …and corrective action as appropriate in accordance with established policies. 2 . Schedules staff coverage for multi-site service areas. Matches workload and ... levels to meet user demands. 10. Monitor and ensure daily operational compliance with the standards governing sterile processing activities 11. Works with Quality… more
    UM FDSP Associates, PA (02/14/19)
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  • Sr Compliance Professional

    Humana (Miami, FL)
    Description The Senior Compliance ( UM ) Professional conducts and summarizes compliance audits. The Senior Compliance ( UM ) Professional work ... will then have the flexibility to work from home 2 days a week. Occasional overtime as needed based...based on the needs of the business. The Senior Compliance ( UM ) Professional collects and… more
    Humana (03/21/19)
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  • Clinical Assurance Compliance Nurse…

    LA Care Health Plan (Los Angeles, CA)
    … with regulatory and accreditation standards. Develop and implement procedures to assurance compliance with care coordination and documentation of UM and CM ... Clinical Assurance Compliance Nurse Specialist, RN (Temp) Job Category: Clinical...nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make… more
    LA Care Health Plan (03/29/19)
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  • Supervisor, Utilization Management, RN

    LA Care Health Plan (Los Angeles, CA)
    …residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the ... required to achieve that purpose. Job Summary The Supervisor of Utilization Management ( UM ), RN is responsible for executing the day-to-day operations of the UM more
    LA Care Health Plan (03/27/19)
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  • Utilization Management Specialist, RN

    LA Care Health Plan (Los Angeles, CA)
    …for UM or CM. Knowledge of DHCS or CMS requirements for health plan compliance with UM or CM. Professional Licenses Current and unrestricted CA RN ... Bachelor's Degree: 5 years of varied clinical experience in an acute hospital setting. 2 years UM experience in a hospital or HMO setting. 2 years CM… more
    LA Care Health Plan (04/03/19)
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  • Performance Management Nurse Specialist, RN (Temp)

    LA Care Health Plan (Los Angeles, CA)
    …ongoing basis. Develop mechanism to track and trend progress of the delegates compliance to UM standards and identify system-wide issues. Provide training, ... performing UM oversight, including auditing. Managed Health Care experience. Professional Licenses Registered Nurse (RN) Additional Information LA Care offers a… more
    LA Care Health Plan (03/29/19)
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