- Molina Healthcare (Long Beach, CA)
- …setting + 5+ years of clinical correspondence processing and quality review experience + **Bilingual- Spanish** + ** UM experience** To all current Molina ... **Job Description** **Job Summary** The Clinical Correspondence Review Nurse...are seeking a candidate with a RN license and UM experience. Prior Case Management experience highly preferred. Strong… more
- Magellan Health Services (Maryland Heights, MO)
- …correspondence and review requests for new or modifications to existing correspondence templates. + Oversees clinical correspondence for all products ... preferred. Responsible for the development, approval, and maintenance of corporate clinical correspondence to ensure compliance with legislative and… more
- Kepro (ND)
- …join our growing team. Job Summary: Our Nurse Clinical Reviewer will use clinical expertise for the review of medical records against appropriate criteria in ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...compact state license. + 1+ years of Utilization experience Review ( UM ) and/or Prior Authorization or related… more
- Amity Foundation (Tucson, AZ)
- …Clinical Documentation Specialist is an entry-level position and assists the Clinical Advisor, Campus Demonstrators and the Utilization Review Specialist with ... periodically during their stay. * Produce weekly and monthly reports as required by Clinical Advisor. * Handle phone calls and correspondence as required *… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... Department of Pathology is currently seeking a full time Clinical Program Coordinator to work in Miami. The ...duties for all staff members, reimbursing the county and UM appropriately. + Invoicing of all clients on a… more
- InnovaCare (San Juan, PR)
- …the business. MMM Holdings, Inc.Job Description Inpatient Unit POSITION: Concurrent Review Nurse (CRN) POSITION DESCRIPTION Manages the inpatient utilization of ... any processes not in compliance with the Plan's SNP policies and MOC requirements. Clinical staff who do not complete the required annual training may not perform… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... setting. Performs telephonic and/or on site admission and concurrent review , and collaborates with onsite staff, physicians, providers, member/family interaction… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Department ... with coordination and planning of monthly research Program meetings involving SCCC members, UM faculty and guests external to UM including notifying members of… more
- Conviva (Tallahassee, FL)
- …Typically works on semi-routine assignments. Shift Hours - 8a - 5 The UM Administration Coordinator - Phone Intake provides non- clinical support for the ... lives, the lives of our patients, and the healthcare industry. The UM Administration Coordinator - Phone Intake contributes to administration of utilization… more
- University of Michigan (Ann Arbor, MI)
- …will coordinate the annual faculty recruitment process every fall and annual faculty review process in the spring/summer. This role reports to the Manager of ... complexity of emergency medical care. We pursue this mission through advanced clinical practice, cutting edge research, innovative education, and service to the… more
- McLaren Health Care (Detroit, MI)
- **Position Summary:** Responsible for providing assistance to the Utilization Manager ( UM ) RN in the coordination of patient admission and continued stay reviews, as ... **Essential Functions and Responsibilities as Assigned:** 1. Collaborates with the UM RN to determine the appropriate hospital setting (inpatient vs. observation)… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... + Responds to routine inquiries from external or internal sources with standard correspondence or other messaging. + Plans meetings and takes detailed minutes, as… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . This ... Relations and the Office of Research Administration. + Analyze incoming correspondence and projects, disseminate as appropriate, and ensure timely responses or… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... and implementation of innovative educational programs throughout the University of Miami ( UM ), Miller School of Medicine, and the Department of Public Health… more
- Cedars-Sinai (Beverly Hills, CA)
- …Additionally, providing clinical support and oversight for all utilization management ( UM ) activities on an ongoing basis, in accordance with CSMCF policies and ... pharmacists, nurses and other health care professionals. Some patient correspondence may occur. + Assist with training of pharmacy...as requested. + With the team, develops and implements clinical criteria for the review of non-formulary… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The UHealth ... priority or confidential inquiries from external or internal sources with correspondence or other messaging on behalf of department leadership. Plans meetings… more
- University of Miami (Coral Gables, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Manager, ... Programs is responsible for managing the Graduate Clinical programs inclusive of the Doctor of Nursing Practice and Masters of Nursing Programs. This position works… more
- Actalent (Rancho Cordova, CA)
- …access to appropriate care for members with urgent needs + Prepares and submits clinical review cases to Medical Director (MD) for medical director oversight and ... implementation of a proactive approach to improve and standardize overall retro claims review for clinical perspectives. Skills: Acute Care, Concurrent Review… more
- Point32Health (Canton, MA)
- …desired outcomes. + Proven ability to integrate compliance requirements into utilization review operations and clinical system documentation + Influencing others ... and team managers on regulations to inform operational processes that support UM functions; and to address questions related to individual member coverage requests.… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... the lead coordinator/nurse manager.*Submission of initial feasibility request with UM leadership*Route CDA/NDA/Other sponsored items with ORA/RIM*Advise resident physicians… more