• Remote Care Review Clinician

    Molina Healthcare (TX)
    …to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional ... **JOB DESCRIPTION** **Opportunity for experienced Utilization Review RN in the state of Texas. You...as well. Preference will be given to those whose UM experience is within another MCO like Molina; experience… more
    Molina Healthcare (11/23/24)
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  • Care Review Clinician

    Molina Healthcare (Milwaukee, WI)
    …we are seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care , Concurrent Review / Utilization Review / Utilization Management and ... programs. + Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina… more
    Molina Healthcare (11/06/24)
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  • Care Review Clinician

    Molina Healthcare (WI)
    …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 (11/22/24)
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  • Care Review Clinician , Prior…

    Molina Healthcare (UT)
    …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 , for… more
    Molina Healthcare (11/20/24)
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  • Excess Risk Managed Care Clinician

    Highmark Health (Columbus, OH)
    …assessments regarding potential claims.Communicate with TPA Case Managers and/or their contracted CM/ UM vendors to ensure effective case/ care management, of all ... for analyzing clinical data to assess potential stop loss and managed care claim liability, utilizing Case Management oversight techniques to ensure front line… more
    Highmark Health (11/25/24)
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  • Inpatient Review Clinician (RN)…

    Molina Healthcare (Lincoln, NE)
    …to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional ... or ER unit. Previous experience in BEHAVIORAL HEALTH, Psychiatric Hospital Acute Care , Concurrent Review /Utilization Review / Utilization Management and… more
    Molina Healthcare (11/10/24)
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  • Inpatient Review Clinician (RN)…

    Molina Healthcare (Oakland, CA)
    …to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional ... **EMERGENCY ROOM ADMISSIONS REVIEW NURSE** **_PERMANENT SHIFT WILL BE :_** **_12...assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long… more
    Molina Healthcare (11/23/24)
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  • Nurse Clinician : Prior Authorization:…

    Molina Healthcare (San Bernardino, CA)
    _JOB TITLE: CARE REVIEW CLINICIAN , PRIOR AUTHORIZATION (REGISTERED NURSE, OR LVN)_ **JOB DESCRIPTION** **Job Summary** Molina Healthcare Services (HCS) works ... programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies...as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3… more
    Molina Healthcare (10/17/24)
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  • LVN or RN Clinician , Prior Authorization…

    Molina Healthcare (ID)
    …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 (11/09/24)
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  • Registered Nurse Clinician , Prior Auth…

    Molina Healthcare (IA)
    …to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional ... Medical, or ER unit. _with previous experience in hospital acute care , Inpatient Review , Prior Authorizations, Utilization Review / Utilization Management… more
    Molina Healthcare (11/16/24)
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  • Utilization Review Nurse

    US Tech Solutions (Chicago, IL)
    …+ MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... objectives **Responsibilities:** + Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. +… more
    US Tech Solutions (10/18/24)
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  • Utilization Review Nurse

    US Tech Solutions (May, OK)
    …. MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF ... objectives Responsibilities: . Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. .… more
    US Tech Solutions (10/18/24)
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  • Medical Assistant

    University of Michigan (Ann Arbor, MI)
    …and wellness care to University of Michigan students, as well as primary care services for eligible UM faculty and staff. UHS is actively seeing ... UHS. MAs are frontline in providing the highest quality care for students and other UM affiliated...families according to the teaching plan established by a clinician **Required Qualifications + High school diploma or GED… more
    University of Michigan (11/16/24)
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  • Clinical Appeals, RN, Remote

    RWJBarnabas Health (Oceanport, NJ)
    …have proficiency with online nationally recognized UM criteria, including Milliman Care Guidelines (MCG) and/or InterQual (IQ). + Review patient medical ... the last 2 years in a facility environment + Minimum of 2 years UR/ UM /CM Preferred: + Medical-surgical/critical care experience Other Duties: Please note this… more
    RWJBarnabas Health (11/09/24)
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  • Behavioral Health Medical Director

    Kepro (Indianapolis, IN)
    …or Quality Assurance committee responsibility in a hospital setting. + Utilization Management ( UM ) review experience. + Experience as a physician executive with ... 2+ years as a Medical Director in a managed care company. + Board certification in a clinical specialty...A strong knowledge of Quality Assurance (QA) and Utilization Review (UR). + A contemporary clinician who… more
    Kepro (11/26/24)
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  • Quality Management Nurse Consultant

    US Tech Solutions (RI)
    …+ MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... **Job Description:** + Responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets data obtained from… more
    US Tech Solutions (10/18/24)
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  • Assistant or Associate Professor of Clinical…

    University of Miami (Miami, FL)
    …pediatrics units, students and residents are active participants in our multidisciplinary care . Our faculty are highly dedicated clinician educators committed 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) . Academic Pediatric Hospitalist… more
    University of Miami (10/16/24)
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  • Registered Dietitian Nutritionist

    University of Michigan (Ann Arbor, MI)
    …Medicine is seeking a full-time Registered Dietitian Nutritionist (RDN) to provide nutrition care to a variety of medical and surgical patients. This position will ... perform nutrition assessments and develop nutrition care plans using the Academy of Nutrition and Dietetics...+ Certified Diabetes Educator (CDE) + Certified Nutrition Support Clinician (CNSC) + Certified Specialist in Oncology Nutrition (CSO)… more
    University of Michigan (11/14/24)
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  • Manager, Research Laboratory

    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 ... procedures, and that technical/research personnel is informed of and comply with UM fiscal and personnel policies and procedures; maintains appropriate files and… more
    University of Miami (10/01/24)
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