- AmeriHealth Caritas Health Plan (Philadelphia, PA)
- …ready to make an impact behind the scenes, this is your moment. As a Clinical Care Reviewer , you'll evaluate inpatient, outpatient, pediatric, or behavioral ... your clinical expertise helps shape better outcomes. We're hiring Clinical Care Reviewers across multiple specialties-medical and behavioral health-for roles… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- Clinical Review Manager - The BlueAdvantage Inpatient Utilization Management department is looking for an RN with at least 3 years of clinical experience to ... comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review , special review requests, and UM pre-certifications… more
- Highmark Health (Wexford, PA)
- …utilization management ( UM ) coverage requests and prepares such cases for clinical review by a pharmacist and/or medical director when required. (20%) ... pertinent facts, and cites applicable internal policies and guidelines. (20%) Resolves non- clinical issues independently and acts as a liaison between our customer… more
- Advocate Aurora Health (Kenosha, WI)
- …to avoid delays in timely service provision, and implementing and reporting care coordination, discharge planning and utilization management ( UM ) activities. ... UM activities as required based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data,… more
- University of Maryland Medical System (Bel Air, MD)
- …other health organizations to serve as a resource for health promotion and education. Today, UM UCH is the leading health care system and second largest private ... supportive and stimulating environment. University of Maryland Upper Chesapeake Health ( UM UCH) offers the residents of northeastern Maryland an unparalleled… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …and partners with key leaders in the development and implementation of UM polices/procedures, clinical and non- clinical programs, interventions, and ... utilization of services in all settings (outpatient, inpatient, concurrent review , and transitions of care ). 3. Take...of statewide initiatives such as CalAIM and Covered California UM polices. 11. Provide clinical support on… more
- University of Michigan (Ann Arbor, MI)
- … Hospital Department MM UH CVC 4B Posting Begin/End Date 7/10/2025 - 7/24/2025 Career Interest Patient Care Clinical Support (MA, Tech) Temporary Job Opening ... patients, populations and communities through excellence in education, patient care , community service, research and technology development, and through leadership… 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 ... Anticipated End Date: 2025-08-01 Position Title: Behavioral Health Care Manager II - Nevada Job Description: Position specific details: The successful candidate will… more
- University of Maryland Medical System (Bel Air, MD)
- …other health organizations to serve as a resource for health promotion and education. Today, UM UCH is the leading health care system and second largest private ... Company Description University of Maryland Upper Chesapeake Health ( UM UCH) offers the residents of northeastern Maryland...greater than 12 months experience. Provides and coordinates independent care to patients within a clinical specialty… more
- Corewell Health (Royal Oak, MI)
- …and discharge planning of all hospitalized patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; ... Level II pediatric trauma designations. The advanced capabilities and clinical expertise within this center have earned it Magnet...of relevant experience Three to five years' experience in care management, utilization review , home care… more
- The University of Miami (Miami, FL)
- …to apply for a faculty or staff position using the Career worklet, please review this tip sheet. The University of Miami UMHC/SCCC has an exciting opportunity for ... coordinator liaises between referral sources, hospitals and physicians to assist with health care needs patients seeking medical care with University of Miami… more
- University of Maryland Medical System (La Plata, MD)
- …outstanding benefits, and the opportunity to make a real impact on patient care . Why Choose UM Charles Regional? Commitment to Excellence - Recognized ... Description Now offering up to $20,000 Sign-On Bonus!! Join UM Charles Regional Medical Center, a proud member of...patient safety and named a high-performing hospital for COPD care by US News & World Report. Community Impact… more
- University of Maryland Medical System (Glen Burnie, MD)
- … care . Job Description As a full time Dietitian you will: Provide clinical nutritional care to patients, which includes screening, assessing, and reassessing ... Company Description Experience the highest level of appreciation at UM Baltimore Washington Medical Center - named Top Workplace...departments, as well as a team of experts who care for our community and one another. The University… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …in providing multidisciplinary staff supervision with a minimum of five years of clinical experience in a variety of managed care treatment settings. Work ... ensuring the highest standards of medical necessity determinations and clinical metrics analysis. You may be a great match...review to ensure timeliness, accuracy and reliability of UM and Appeals reviews. Lead and serve on various… more
- US Tech Solutions (Schenectady, NY)
- …exp. MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. MUST HAVE UM experience, inpatient utilization management review . MUST HAVE 1 YEAR OF ... meet QM objectives Responsibilities: Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations.… more
- University of Maryland Medical System (Towson, MD)
- …work performance. 3. Collaborates with interdisciplinary team to plan and coordinate care addressing patient/family needs. Serves as clinical resource as needed. ... be contributing to a locally and nationally recognized institution. UM St. Joseph has been recognized by The Leapfrog...the development, evaluation and modification of the plan of care . Provides care to those patients via… more
- Blue Shield of California (Oakland, CA)
- …Health Utilization Management (BH UM ). In this role you will conduct clinical review of mental health and substance use authorization requests at various ... levels of care for medical necessity, coding accuracy, medical policy compliance...line of business such as Medicare as needed Gather clinical information and apply the appropriate clinical … more
- The University of Miami (Miami, FL)
- …apply for a faculty or staff position using the Career worklet, please review this tip sheet. The Division of Pediatric Infectious Diseases, Allergy, and Immunology ... will be at the assistant professor level of the clinical educator track. The Department of Pediatrics has an...therapies Genetic testing In addition to delivering excellent patient care , the faculty member will also be responsible for… more
- University of Maryland Medical System (Upper Marlboro, MD)
- … Clinical and/or Technical Skills: Performs a medical chart review , selects and administers appropriate assessment tools, develops individualized treatment ... roots that go as far back as 1895, the UM Rehab & Ortho Institute continues to be a...must demonstrate the knowledge and skills necessary to provide care appropriate to the age, culture, ethnicity, and specific… more
- Molina Healthcare (Long Beach, CA)
- …concurrent review , and manages the denial process. Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home ... local laws and regulatory requirements affecting the medical and clinical staff. MD licenses required for the following states:...includes strategies that ensure a high quality of patient care , ensuring that patients receive the most appropriate … more
