- Integrated Resources, Inc (New York, NY)
- …quality of life for the MetroPlusHealth members. . Coordinate with Utilization Management ( UM ) department on concurrent and retrospective review . . Follow up ... BSN preferred. * Two (2) to three (3) years clinical experience in certified home health agency (CHHA), Lombardi...community setting. . Product of Role & Responsibilities: . Review and evaluate the assessment and UAS information for… more
- NorthBay Health (Fairfield, CA)
- …Management and Population Health which includes: Utilization Management, Utilization Review , Inpatient, Outpatient and Complex Case Management, Discharge Planning, ... cost effective and quality patient outcomes through the supervision of clinical /professional staff, collaboration with medical staff, nursing, and support staff.… more
- The University of Vermont Health Network (Berlin, VT)
- …affirming compliance with CMS' Conditions of Participation regarding Utilization Management with annual review of the UM Plan and assisting with the coordination ... workforce.PRIOR EXPERIENCE3-5 years acute care hospital nurse and/or3-5 years chart review , prior authorizations, managed care, familiarity of clinical … more
- Kepro (Richmond, VA)
- …a vital partner for health solutions in the public sector. Acentra seeks a Behavioral Health UM Clinical Reviewer RN to join our growing team. Job Summary: ... Our Clinical Reviewer RN will use clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements,… more
- Centers Plan for Healthy Living (Margate, FL)
- UM Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #664 Monday, April 29, 2024 Centers Plan for Healthy Living's goal is to create the ... applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help… more
- Kepro (Richmond, VA)
- …pivotal role in managing and coordinating the clinical appeals process with our client. UM Clinical Reviewer : + Using clinical knowledge and nursing ... health solutions in the public sector. Acentra seeks a UM Reviewer & Appeals Coordinator RN/LCSW (Remote... reviewer role - you will utilize clinical expertise for the review of medical… more
- University of Miami (Miami, FL)
- …serves the Miller School of Medicine's educational and biomedical research programs, and UM 's clinical enterprise, UHealth. Library services are also provided to ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Collection Development, Assessment,… more
- Commonwealth Care Alliance (Boston, MA)
- …This Role is Important to Us:** The Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day timely clinical and service authorization ... and organizational determinations. The Utilization Management ( UM ) Reviewer is responsible for day-to-day timely clinical ...) Reviewer is responsible for day-to-day timely clinical and service authorization review for medical… more
- Elevance Health (Colorado Springs, CO)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... location in either Denver, CO or Colorado Springs, CO. The BH Care Manager ( UM ) job progression is primarily a provider facing role although it does involve some… more
- The Arora Group (Bethesda, MD)
- …Care Manager Certified (CMC) + Experience: + Referral Management/Utilization Management (RM/ UM ) experience. + Clinical subspecialty experience in Behavioral ... and cost-effective outcomes, across the continuum of care. + Serves as a clinical case manager and patient advocate, providing advanced practice clinical ,… more
- Elevance Health (Woburn, MA)
- …as an LABA. _The BCBA Autism/BH Care Manager is primarily for conducting the clinical review process for ABA service for the plans contracted by Carelon ... review .** + Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access...behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. + Refers… more
- Elevance Health (Winston Salem, NC)
- …medically necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer ... companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive… more
- Guthrie (Sayre, PA)
- Position Summary: The Utilization Management ( UM ) Reviewer , in collaboration with other internal and external offices, payors, and providers and staff, is ... or service for hospital inpatient admissions and short procedures by translating clinical information to UM requirements (using identified criteria). a)… more
- Baylor Scott & White Health (Temple, TX)
- …Is accountable to provide professional leadership and direction in the utilization/cost management ( UM ) and clinical quality improvement (QI) of the Health Plan, ... UM and QI goals. Works collaboratively as a clinical resource to other plan functions that interface with...utilization/cost and quality outcomes. + Participate in the retrospective review and research of Health Plan performance from summary… more
- YesCare Corp (Cumberland, MD)
- …Adherence to UM programs specific to the contract requirements and corporate's UM and clinical policies and procedures. + Attend facilities' meetings as ... + Utilization Management experience + Must have minimum of 5 years clinical experience in Family Practice, Emergency Medicine, Internal Medicine, Public Health, or… more
- Elevance Health (Beaverton, OR)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... and outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact:** + Uses appropriate screening… more
- University of Miami (Miami, FL)
- …. Department of Radiation Oncology JOB DESCRIPTION UM Title: Professor of Clinical FLSA ... eligible/certified candidate . The candidate is expected to be engaged in clinical , research, teaching, and administrative activities. The department has a strong… more
- University of Miami (Miami, FL)
- …in accordance with the satellite office and University policies. + Works with all UM Heath System clinical sites to assure coordination of services, program ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Bascom Palmer… more
- Molina Healthcare (Bronx, NY)
- …Medicaid and Medicare.** **We are looking for a LPN or LVN Care Review Clinician with Prior Authorization experience. Experience with Utilization Management ( UM ) ... is highly preferred. Additional experience with appeals, quality review , MLTC/LTC experience, and experience with data collection/reports.** **_Bilingual candidates… more
- Molina Healthcare (Bronx, NY)
- …severity of illness and the site of service. **We are seeking a Registered Nurse with UM and Inpatient Review experience. The Care Review Clinician must be ... all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence...teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other… more
