- 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 ... 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
- CHPW (Seattle, WA)
- …an equitable work environment. About the Role The Level I Utilization Management Clinician performs utilization review for medical or behavioral health requests ... Care , preferred. Essential functions and Roles and Responsibilities: Conduct review of hospital notification or prior authorization care requests against… more
- University of Iowa Hospitals & Clinics (Iowa City, IA)
- …criteria to the Physician Advisor or appeal as necessary in accordance with the UM plan. Collaborate with the health care team to determine the appropriate ... Iowa Healthcare Downtown Campus, is looking for a Nurse Clinician to functions as a clinical nurse expert and...specifically regarding the compliance portion of the level of care . Review data specific to utilization management… more
- UnitedHealth Group (San Antonio, TX)
- …Administrative Coordinator to join our team in San Antonio, TX. Optum is a clinician -led care organization that is changing the way clinicians work and live. ... Contacts provider offices to obtain clinical information for medical review by a clinician to meet Center...High School Diploma/GED (or higher) 2+ years of managed care experience in Prior Authorization OR Claim Review… more
- Autonomize Inc (Austin, TX)
- …with urgency, and deeply understands both the "why" and the "how" behind care management, utilization review , quality improvement, and risk adjustment. Your work ... scalable, safe, and valuable AI adoption across functions like UM , case management, and quality programs. This is not...clinician . You don't stop at outputs - you care about outcomes. You build trust, speak boldly, and… more
- PacificSource (Bend, OR)
- …Licensed Clinical Social Worker or other licensed healthcare or behavioral health care clinician , Oregon licensure required. Certified Case Manager Certification ... Utilization Management Manager, as needed. Work collaboratively with the UM Director and Manager Team to develop, implement, and...care management, as well as the inpatient concurrent review process to ensure medical appropriateness, care … more
- UnitedHealth Group (Fort Myers, FL)
- …a Nurse Case Manager II to join our team in Fort Myers, FL. Optum is a clinician -led care organization that is changing the way clinicians work and live. As a ... clinical and administrative staff as well as performs a review for clinical authorizations for inpatient care ...plan and/or action plan for patients Independently confers with UM Medical Directors and/ or Market Medical Directors on… more
- UnitedHealth Group (Syracuse, NY)
- …or Physician Assistant to join our team in Syracuse, 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
- The University of Miami (Miami, FL)
- …how to apply for a faculty or staff position using the Career worklet, please review this tip sheet. This position will serve as the SCCC Manager of research ... procedures, and that technical/research personnel is informed of and comply with UM fiscal and personnel policies and procedures; maintains appropriate files and… 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
- 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
