- MetroPlusHealth (New York, NY)
- …and communicates all potential quality of care concerns to the BH UM Clinician Team Lead in a timely manner Contributes to MetroPlusHealth corporate ... of what you do every day. The Behavioral Health Utilization Management (BH UM ) Clinician is responsible for conducting utilization and quality management… more
- Molina Healthcare (Long Beach, CA)
- …to other clinical programs. Collaborates with multidisciplinary teams to promote Molina Care Model. Adheres to UM policies and procedures. Occasional travel ... team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care ,… 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 ... level clinician utilizes the nursing process in providing patient care and patient/family teaching. The practitioner organizes and implements safe, therapeutic,… more
- UnitedHealth Group (Brooklyn, NY)
- …or Physician Assistant to join our team in Brooklyn, NY. Optum is a clinician -led care organization that is changing the way clinicians work and live. ... warrant or following hospitalization. Meets with members and/or their legal representatives to review newly developed or modified care plans; involves the PCP in… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …and co-occurring psychiatric and substance abuse conditions. POSITION TITLE: Utilization Review Clinician PAY RANGE: LVN/LPT $31.50-37.50 Per Hour ... and optimize reimbursement for external reviewers/third party payers. The Utilization Review Clinician maintains knowledge of, participates in further training… more
- Molina Healthcare (Idaho Falls, ID)
- …to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional ... (RN) license in good standing. **Preferred Experience** Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review / Utilization… more
- Monte Nido (Miami, FL)
- …comprehensive care within an intimate home setting. The Utilization Review ** Clinician ** is responsible for conducting daily administrative and professional ... opportunity for people to realize their healthy selves. **Utilization Review Clinician ** **Monte Nido** **Remote - EST...active treatment team member providing payor needs for next review , guidance on level of care recommendations,… more
- Molina Healthcare (Everett, WA)
- …a candidate with a LICSW, LMFT, LMHC or LPCC licensure with previous UM and managed care experience. Proficient technology experience is highly preferred. ... programs. + Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina… more
- Molina Healthcare (Albuquerque, NM)
- …healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or ... programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies...such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only). Must be able… more
- Molina Healthcare (Fort Worth, TX)
- …to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina care model. + Adheres to utilization management ( UM ) policies and ... or emergency room. + Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review... Care , ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual /… more
- Molina Healthcare (San Jose, CA)
- …to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional ... in Nursing **Preferred Experience** Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review... Care , ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual /… more
- Molina Healthcare (Austin, TX)
- …to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional ... in Nursing **Preferred Experience** Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review... Care , ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual /… more
- Molina Healthcare (Omaha, NE)
- …to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional ... and holidays.** Preferred Experience Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review... Care , ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual /… more
- Molina Healthcare (AZ)
- …to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional ... team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care ,… more
- CVS Health (Hartford, CT)
- …must hold an unrestricted license in their state of residence + 5 years' managed care experience, which can include Case Management, UM , Precert + Ability to ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions… more
- Commonwealth Care Alliance (Boston, MA)
- …with the VP of UM to direct the efforts of the utilization review and pre-certification functions to accomplish objectives within policy and budget. + Serve as a ... the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will...on a weekly basis + Provide education to internal care management and clinician staff + Provide… more
- US Tech Solutions (Chicago, IL)
- …+ MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... objectives **Responsibilities:** + Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. +… more
- US Tech Solutions (May, OK)
- …. MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF ... objectives Responsibilities: . Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. .… more
- Elevance Health (NV)
- Position specific details: The successful candidate will be an independently licensed clinician residing and licensed in Nevada. **Work Hours: 8am-5pm PST** **Work ... and ensures essential face-to-face onboarding and skill development. The **Behavioral Health Care Manager II - Nevada** is responsible for managing psychiatric and… more
- Humana (Montgomery, AL)
- …key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus on our 5+ million ... and partnering across the enterprise (eg, with Clinical Operations, Markets, Care Management, Analytics, Pharmacy, etc.) to develop discrete, high-value strategies… more
