- Accounting Now (Carson City, NV)
- …quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contractPerforms psychiatric and substance abuse or ... review Will use appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access...if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis… more
- Staffing Now (Carson City, NV)
- …quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. Performs psychiatric and substance abuse ... review . Will use appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access...if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis… more
- Pacer Staffing (Atlanta, GA)
- …manuals, computer files, andmedical documentation. . Assists staff with complex, in-depth analysis and review of UM processes. . Develops and maintains UM ... Job Title: Clinical Ops and Policy Clinical Location:...contributor position reports to the Directors of Utilization Management ( UM ) and Referral Management (RM) and supports both RM… more
- Pacer Staffing (Atlanta, GA)
- …manuals, computer files, and medical documentation. Assists staff with complex, in-depth analysis and review of UM processes. Develops and maintains UM and ... Summary: This individual contributor position reports to the Directors of Utilization Management ( UM ) and Referral Management (RM) and supports both RM and UM … more
- VNS Health (Manhattan, NY)
- …practices, and technology through comprehensive orientation and ongoing education. Oversees clinical peer review , and manages the recruitment, education, ... VNS Health is seeking a Social Work Licensed Clinical Social Worker for a job in Manhattan,...behavioral health sections of the Quality Management (QM)/Utilization Management ( UM ) Plan. Oversees the administration of all BH QM/… 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
- Centers Plan for Healthy Living (Margate, FL)
- UM Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #664 Monday, September 9, 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
- WellSense (Boston, MA)
- Senior Manager of Clinical UM - BH WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through ... Oversees the analysis, development, implementation and evaluation of the UM clinical programs and policies so that...Minimum five years of experience with prior authorization, utilization review , and discharge planning . Minimum of three years… more
- Molina Healthcare (Long Beach, CA)
- …Care setting + 5+ years of clinical correspondence processing and quality review experience + **Bilingual- Spanish** + ** UM experience** To all current ... **Job Description** **Job Summary** The Clinical Correspondence Review Nurse is responsible...are seeking a candidate with a RN license and UM experience. Prior Case Management experience highly preferred. Strong… more
- AmeriHealth Caritas (Charlotte, NC)
- …information necessary to perform a thorough medical necessity review . It is within Clinical Care Reviewer UM discretion to pend requests for additional ... on a 24/7, 365 basis. Under the direction of the supervisor, the Clinical Care Reviewer UM is responsible for completing medical necessity reviews. Using … more
- Integra Partners (Troy, MI)
- …and clinical processes + Develop and deliver comprehensive training programs for UM clinical staff on: + Writing clear and concise clinical ... educator to join our Operations Training & Development team as an Operations UM Training Specialist, specializing in Utilization Management ( UM ) processes. The… more
- Healthfirst (NY)
- …on dosing, indication, weight, BMI and other clinical considerations + Develop clinical criteria and medical policies for the review of medications + Ensure ... **Duties & Responsibilities:** + Monitor and review prior authorization requests for medications + Calculate...standing. + Work experience conducting prior authorization reviews + Clinical knowledge of pharmaceuticals and disease states in order… more
- Healthfirst (NY)
- …approvals from key governance committee members. + Review the appropriate UM or related clinical and medical policies, job aids/procedures, and ... spearhead the policy work that will inform Medical and Clinical strategy + Perform editorial formatting and review...ad hoc medical condition research per Medical Director and/or UM Clinical Director requests. + Collaborate with… more
- Kepro (AR)
- …deliverables and provide day-to-day oversight to manage multiple areas of the UM program and oversee the implementation of clinical contract requirements ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… more
- The Cigna Group (Franklin, TN)
- … clinical compliance within the UM programs, including matters concerning clinical policy, quality management (QM), program development, review of UM ... **Responsibilities and Essential Functions** + Responsible for development of clinical policy, clinical review decisions,...Client teams for clinical matters related to UM client contracts + Review official program… more
- University of Miami (Miami, FL)
- …and Clinical Information Services (LRCIS) The University of Miami ( UM ) Libraries seeks nominations and applications for a creative, innovative professional to ... and Information Services Librarian of the Department of Learning, Research, and Clinical Information Services (LRCIS) on UM 's Medical Campus. Under the… more
- AmeriHealth Caritas (Dublin, OH)
- …information necessary to perform a thorough medical necessity review . It is within Clinical Care Reviewer UM discretion to pend requests for additional ... **RN Clinical Care Reviewer , Concurrent Review ,...365 basis. Under the direction of the supervisor, the Clinical Care Reviewer UM is responsible… more
- University of Miami (Coral Gables, FL)
- …sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Associate Dean for Graduate Clinical Programs The University of Miami ( UM ... eligible for appointment at the rank of Associate Professor or Professor of Clinical . UM is one of the top research universities and academic medical centers in… more
- University of Miami (Coral Gables, 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) . The University of… more
- Apex Health Solutions (Houston, TX)
- …Solutions' members for the utilization review (UR) of healthcare services. The UM Reviewer will be responsible for complying with utilization review ... Summary: The UM Reviewer serves as a contact...review /precertification requirements. Collects and/or documents all required enrollee clinical and co-morbidity information during the pre-authorization process to… more
