- Centers Plan for Healthy Living (Margate, FL)
- UM Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #664 Monday, December 2, 2024 Centers Plan for Healthy Living's goal is to create the ... more
- Sutter Health (Sacramento, CA)
- …years of recent relevant experience. * 2 years experience in Utilization Management ( UM ) and Clinical Denial Management Preferred **SKILLS AND KNOWLEDGE:** * ... more
- CVS Health (Hartford, CT)
- … Clinical Operations, Clinical Account Management, Formulary Administration, and Clinical Affairs. The UM Clinical Development pharmacist may be ... more
- Elevance Health (Indianapolis, IN)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... more
- Elevance Health (Indianapolis, IN)
- …make an impact:** + Coordinating utilization management process including appropriate use of UM Clinical Guidelines to refer cases to Peer Reviewers. + ... more
- Fallon Health (Worcester, MA)
- …relevant clinical information from medical care providers as needed for the clinical review process + Conducts clinical reviews of retrospective and ... 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 ... more
- University of Miami (Coral Gables, FL)
- …CTO is an enterprise level executive and will oversee all IT infrastructure services across UM and UHealth in support of education, clinical care , and research ... more
- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The UM Administration Coordinator 2 provides non- clinical support for the policies and procedures ... more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for members who ... more
- US Tech Solutions (Canton, MA)
- …possible extension)** Notes: Fully remote, MA license required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- ... more
- Sharp HealthCare (San Diego, CA)
- …other sources. + Achieves and maintains benchmarked utilization and cost management ( UM ) goals and clinical quality improvement (QI) objectives, in conjunction ... more
- AmeriHealth Caritas (Charleston, SC)
- …perform a thorough medical necessity review . It is within the BH UM Reviewer 's discretion to retain requests for additional information and/or request ... more
- Hackensack Meridian Health (Hackensack, NJ)
- …University Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and transitions ... more
- Point32Health (MA)
- …day in service to our members, partners, colleagues and communities. **Job Summary** The Clinical Reviewer is a licensed Registered Nurse that is expected to ... more
- University of Maryland, Baltimore (Baltimore, MD)
- …patient care decision making * In collaboration with Oncology Practice Leadership and UM SJMC Leadership teams, develop annual clinical operational goals and ... more
- Corewell Health (Grand Rapids, MI)
- …high level of collaboration, patient-centered care and evidence-based medicine. The Physician Reviewer can expect to work approximately 2-4 hours on 1- day holidays, ... more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …the diagnosis and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual ... more
- Hackensack Meridian Health (Hackensack, NJ)
- …and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and transitions of ... more
- Molina Healthcare (Long Beach, CA)
- …The **Delegation Oversight Nurse** is responsible for ensuring that Molina Healthcare's UM delegates are compliant all applicable State, CMS, and NCQA requirements, ... more