- Integra Partners (Troy, MI)
- …educator to join our Operations Training & Development team as an Operations UM Training Specialist, specializing in Utilization Management ( UM ) processes. The ... and facilitation of the Operations training and development program. The Operations UM Training Specialist will work in collaboration with Operations leadership and… more
- Molina Healthcare (Los Angeles, CA)
- …The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM delegates are compliant all applicable State, CMS, and NCQA requirements, as ... Assists with preparation of delegation summary reports submitted to the EQIC and/or UM Committees. + Participates as needed in Joint Operation Committees (JOC's) for… more
- Sharp HealthCare (San Diego, CA)
- …1 **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse ( LVN ) - CA Board of Vocational Nursing & Psychiatric Technicians **Hours** **:** ... SNF, medical clinic etc.) + California Licensed Vocational Nurse ( LVN ) - CA Board of Vocational Nursing & Psychiatric...the decisions to the appropriate persons and documents per UM policy. + Applies approved criteria to medical informationApply… more
- RWJBarnabas Health (Oceanport, NJ)
- …skills. Qualifications: Required: + Must possess a valid nursing license (Current, valid RN/LPN/ LVN licensure) + Must possess MCG UM Certification or obtain ... include the following: + Must have proficiency with online nationally recognized UM criteria, including Milliman Care Guidelines (MCG) and/or InterQual (IQ). +… more
- Dignity Health (Rancho Cordova, CA)
- …and assessments for orientation of new staff in Utilization Management ( UM )/Continuing Care (CC). Additionally, conducts, coordinates, and evaluates orientation and ... ongoing training and education for non-provider clinical staff (ie MA, LVN , RN, CHW, Navigator, Clerks, Interns, etc). - Assesses clinical performance in relation to… more
- Molina Healthcare (Temecula, CA)
- **_JOB TITLE: CARE REVIEW CLINICIAN, PRIOR AUTHORIZATION (REGISTERED NURSE, OR LVN )_** **For this position we are seeking a Nurse with previous experience in Prior ... teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other...of an accredited Registered Nurse (RN), Licensed Vocational Nurse ( LVN ) or Licensed Practical Nurse (LPN) Program OR a… more
- Actalent (Doral, FL)
- Utilization Management Nurse Job Description The role of the Utilization Management ( UM ) Nurse is to promote quality, cost-effective outcomes for a population by ... required to meet desired health and social outcomes. The UM Nurse is responsible for providing patient-centered care across...& Qualifications + Associate's degree in Nursing + Active LVN /LPN license in the state of California + Minimum… more
- LA Care Health Plan (Los Angeles, CA)
- …and must adhere to regulatory mandates that apply to Utilization Management ( UM ) and Care Management (CM). Collaborate with Skilled Nursing Facilities (SNF), ... physical health, behavioral health, social services, and MLTSS. Responsible for UM authorization functions for services requiring prior auths. Provides direction to… more
- Molina Healthcare (Spokane, WA)
- …Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or ... following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse ( LVN ) or Licensed Practical Nurse (LPN) Program OR a bachelor's or master's… more