- UM FDSP Associates PA (Baltimore, MD)
- …order to continue the high degree of excellence in thepursuit of academic and clinical education. In addition, UM FDSPAssociates PA administers and operates the ... SUMMARY: UM FDSP Associates is anon-profit affiliate of the... FDSP Associates is the organization that provides patient care focused staffingfor clinic operations so that faculty and… more
- RIT Solutions, Inc. (New York, NY)
- …the services and resources required to meet desired health and social outcomes. The UM Nurse is responsible for providing patient-centered care across the ... Job Title: UM Nurse (California License) - Must be licensed...and coordination across settings, identifying member needs, planning for care , monitoring the efficacy of interventions, and advocating to… more
- WELLSPACE HEALTH (Sacramento, CA)
- Job Details Job Location 164 - 1500 Expo Parkway - Sacramento, CA Description Clinical Care Manager Department: Nexus Location: 164 Reports to: UM Director ... Home and a Behavioral Health Home. Position Summary The Clinical Care Manager delivers indirect patient ...care processes as indicated to ensure optimal patient care . Attend annual review and department in… more
- Autonomize Inc (Austin, TX)
- …like UM , case management, and quality programs. This is not a traditional clinical reviewer role - it's a high-ownership position for someone who thrives on ... deeply understands both the "why" and the "how" behind care management, utilization review , quality improvement, and... clinical value. Constantly improve QA, documentation, and clinical review workflows to support velocity and… more
- Connecticut Children's (Hartford, CT)
- …of level of care based on medical record documentation. -9% Gathers clinical information to conduct continued stay utilization review activities with payers ... and improve the role of Case Management and patient/family care through the institution. Lead will identify challenges and... Plan. -5% Escalates cases as appropriate for secondary review . -5% Performs concurrent and retrospective clinical … more
- Wellmark, Inc. (Des Moines, IA)
- …increasing responsibilities and expertise is essential. Masterful at delivering timely UM decisions based on evidence, cogent clinical reasoning, benefit ... of where the evidence is not definitive; and (c) review of clinical documents submitted by the...of medical necessity. Effectively engage with external physicians, health care facility UM leadership, and other stakeholders… more
- Molina Healthcare (Long Beach, CA)
- …other clinical programs. Collaborates with multidisciplinary teams to promote Molina Care Model. Adheres to UM policies and procedures. Occasional travel to ... Education Bachelor's Degree in Nursing Preferred Experience Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review / Utilization… more
- Advocate Aurora Health (Oak Lawn, IL)
- …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
- CHPW (Seattle, WA)
- …Responsibilities: Conduct review of hospital notification or prior authorization care requests against established clinical guidelines and health plan ... for medical review . Regularly communicates with the UM Manager, Medical Director, physician advisor/ reviewer and...with the UM Manager, Medical Director, physician advisor/ reviewer and primary care physician for support,… more
- University Hospitals (Beachwood, OH)
- …(Required) and (BSN) Bachelor's Degree in Nursing (Preferred) Work Experience 3+ years Clinical experience in acute care setting (Required) and 3+ years Of ... regulatory / payer and internal requirement. Collaborate with physicians, UM Nurses, PAS, and other members of the Interdisciplinary...experience in managed care or utilization review (Preferred) and Experience… more
- University of Maryland Medical System (Baltimore, MD)
- …all nurses who have greater than 12 months experience. Provides and coordinates independent care to patients within a clinical specialty as a fully effective and ... Company Description Join the UM Rehab Team! At UM Rehab,...of all job duties performed by personnel so classified. Clinical Practice: Provides independent care to unit… 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
- UnitedHealth Group (San Antonio, TX)
- …Medical Directors, UM Nurses and Case Managers Contacts provider offices to obtain clinical information for medical review by a clinician to meet Center for ... of the Optum family of businesses, is seeking a Clinical Administrative Coordinator to join our team in San...High School Diploma/GED (or higher) 2+ years of managed care experience in Prior Authorization OR Claim Review… more
- University of Maryland Medical System (Towson, MD)
- …continuum. He/ she works collaboratively with physicians and other members of the health care team to achieve the highest quality clinical outcomes with the most ... be contributing to a locally and nationally recognized institution. UM St. Joseph has been recognized by The Leapfrog...a top employer by Baltimore magazine. Job Description The Care Manager coordinates the care and service… more
- Pennsylvania Medicine (Trenton, NJ)
- …pre-certifications as well as coordination of utilization reviews with utilization management reviewer . Timely and accurate completion of UM forms. Performance ... is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …committee participation. The Medical Director of Behavioral Health oversees the inpatient/concurrent review process, care integration efforts, and all levels of ... services, medication management, and coordination of behavioral health services and primary care . Provides direction of current clinical practices for behavioral… more
- Commonspirit Health (Long Beach, CA)
- …reliability test for Utilization Review product(s) used. Able to apply clinical guidelines to ensure progression of care . Must have critical thinking ... nursing experience. Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred Knowledge of managed care and payer environment… more
- University of Maryland Medical System (Upper Marlboro, MD)
- …all nurses who have greater than 12 months experience. Provides and coordinates independent care to patients within a clinical specialty as a fully effective and ... an exhaustive list of all job duties performed by personnel so classified. Clinical Practice: Provides independent care to unit specific patient population;… more
- University of Maryland Medical System (Aberdeen, 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 an unparalleled combination of clinical … more
- University of Maryland Medical System (Towson, MD)
- …professionals means you'll be contributing to a locally and nationally recognized institution. UM St. Joseph has been recognized by The Leapfrog Group as a grade ... in both the state and Baltimore Metro area, making UM St. Joseph the highest-ranking community hospital in Maryland....role is designed for the nurse who is a clinical and professional leader at the unit level .… more
