- 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
- Humana (Madison, WI)
- …works on semi-routine assignments. **Achieve your best at Humana. Join Us!** The UM Administration Coordinator 2 provides non- clinical support for the policies ... a part of our caring community and help us put health first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM … more
- Healthfirst (NY)
- …committee members. + Review the appropriate UM or related clinical and medical policies, job aids/procedures, and correspondence and make recommendations ... 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 (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
- University of Miami (Miami, FL)
- …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 SCCC ... CRS department is seeking a Clinical Research Data Specialist the CRDS assists in creating,...Verifies entries for accuracy and completeness. Sorts and files correspondence , reports, and other relevant materials. Processes documents requiring… 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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Disease Management, and Quality Department as needed. + Develop and review member centered documentation and correspondence reflecting determinations in ... Nurse performs daily medical necessity reviews. This position reports to the Director, Clinical Programs. This job description is not designed to cover or contain a… 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