- 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 ... applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help… 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:** ... Office-Valley **Position Overview:** Manages the operations of the centralized Utilization review department for Sutter Health entities in accordance with current… more
- CVS Health (Woonsocket, RI)
- … Clinical Operations, Clinical Account Management, Formulary Administration, and Clinical Affairs. The UM Clinical Development pharmacist may be ... more personal, convenient and affordable. **Position Summary** The Utilization Management ( UM ) clinical development pharmacist will develop clinically and… more
- The Cigna Group (Bloomfield, CT)
- …an active caseload of inpatient case management cases for Cigna. + Uses clinical knowledge to assess inpatient admission level of care, treatment plan and goals, ... Cigna's approved guidelines and tools to rigorously assess the clinical status of the member, the level of care...impact. + Access the approved Cigna guidelines for inpatient review and directs communication with the facility to elicit… more
- Elevance Health (Norfolk, VA)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... PulsePoint office. This utilization management role is responsible for utilization management review for Behavior Analysis services. **How you will make an impact:**… 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 (CO)
- …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
- 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …of the Senior Medical Director of the Physician Review Unit (PRU), the reviewer also provides clinical leadership in other areas of BCBSMA. The physician ... determination depends, making reasonable efforts to obtain relevant information via UM clinical reviewers, peer-to-peer outreach, and/or direct provider EMR… 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
- 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 ... detailed plan process involving management staff, senior leadership and members of the UM 's clinical and educational communities. + Strong interpersonal and… more
- Prime Therapeutics (Columbus, OH)
- …. + Provides strategic support and coaching to team members. + Builds UM Clinical Development team; works to develop employee?s skills, evaluates performance ... and provide feedback, and oversees resolution of employee relations issues. + Represents UM Clinical Development capabilities in RFP inquiries and sales finalist… more
- Fairview Health Services (St. Paul, MN)
- …treatment setting reviews to ensure compliance with applicable criteria. + Consult with clinical UM Specialists and Liaisons and/or medical directors to ensure ... to the Manager of Utilization Management, will primarily be responsible for managing the UM nursing staff in the day to day operations of the department. This… more
- Point32Health (MA)
- …in service to our members, partners, colleagues and communities. **Job Summary** The Clinical Reviewer , Inpatient RN, is a licensed professional that is expected ... acute, subacute, acute rehabilitation, LTAC, CORF and others. The Clinical Reviewer , Inpatient RN is responsible for...clinical nursing experience. * Minimum 3 years of UM experience, preferably in an inpatient setting or managed… more
- University of Miami (Coral Gables, FL)
- …anesthetist (CRNA) faculty for full- time positions at the Assistant/Associate/Full Professor of Clinical rank. UM is one of the top research universities and ... 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) . NURSE ANESTHESIA FULL… more
- CVS Health (Springfield, IL)
- …competitors, reduce liquidated damages, and support accreditation activities. Supporting the UM team in predetermination reviews and providing clinical , coding, ... sustainable competitive business advantage by supporting the plan goals. Review , interpret and analyze data and trends at State...expertise. Work closely with UM team and clinical leaders to identify and effectively manage emerging utilization… 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 ... selected utilization/cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations for updating current...and UM platforms. + Oversees A/G and UM reviews of all clinical reviewers. +… 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 ... is responsible for completing medical necessity reviews. ;Using clinical knowledge and experience, the clinician reviews provider requests...clarification. The BH UM Reviewer will use his/her professional judgment… 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 ... clinically complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the...functions as a member of the Precert / Outpatient UM team and works under the general direction of… more
- Point32Health (MA)
- …**- what you will be doing** + **Utilization Management** + Performs clinical review of prospective, concurrent, and retrospective coverage requests for ... and concerns. + Supports the provider inquiry line for peer-to-peer discussions. + Performs clinical review of expedited and standard appeals for all lines of… more