- Apex Health Solutions (Houston, TX)
- Summary: The UM Reviewer serves as a contact...utilization review (UR) of healthcare services. The UM Reviewer will be responsible for complying ... or UR questions or issues arise. To support care management initiatives, the UM Reviewer should also identify enrollees in need of case/disease management… more
- 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 ultimate ... for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help identify and manage… more
- US Tech Solutions (Canton, MA)
- …extension)** Notes: Fully remote, MA license required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that is ... complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical...functions as a member of the Precert / Outpatient UM team and works under the general direction of… more
- Point32Health (MA)
- …to our members, partners, colleagues and communities. **Job Summary** The Clinical Reviewer is a licensed Registered Nurse that is expected to function independently ... complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical...functions as a member of the Precert / Outpatient UM team and works under the general direction of… 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, ... + Ability to work within various systems and use technology efficiently (PA Logic UM portal) About Corewell Health As a team member at Corewell Health, you will… more
- Evolent (Austin, TX)
- …of direct clinical patient care + **Minimum one year of experience with Utilization Review ( UM ) in a managed care environment** + Cardiology and Oncology ... better health outcomes. **Collaboration Opportunities:** + Works with the physician reviewer to monitor the adverse determination process and ensure notification… more
- Humana (Jefferson City, MO)
- …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 ... and most appropriate treatment, care or services for members. UM Administration Coordinator 2 + Support the UM...+ 1 or more years of experience with Utilization Review and/or Prior Authorization + 1 or more years… 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, ... looking for LVN's with at least 4 years of UM experience, NCQA accreditation and knowledge of InterQual /...(LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable… more
- L3Harris (Greenville, TX)
- …in the interest of national security. Job Title: Lead, Aerodynamics Engineer / ODA UM Job Code: 21347 Job Location: Greenville or Plano, TX (100% On-site) Job ... Engineering (ASE) team as an aerodynamics engineer and ODA UM with delegation in Structures/Aerodynamics Loads. In this role,...Write analytical reports, test plans, and test reports. + Review and approve flight test procedures and loads reports… more
- Textron (Fort Worth, TX)
- **Electromagnetic Effects Engineer - HIRF Lightning UM ** **Description** _We're more than aviation experts, we're pioneers\. We challenge what's possible\. From ... \. **And we want you\.** **Electromagnetic Effects Engineer \- HIRF Lightning UM ** Responsible for representing Bell aircraft commercial programs as a subject matter… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member ... and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well… more
- Humana (Tallahassee, FL)
- …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 ... assignments. Performs computations. Typically works on semi-routine assignments. The UM Administration Coordinator 2 provides non-clinical support for the policies… more
- Humana (Baton Rouge, LA)
- …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 ... assignments. Performs computations. Typically works on semi-routine assignments. The UM Administration Coordinator 2 provides non-clinical support for the policies… more
- ManpowerGroup (Columbia, SC)
- Our client, a leading healthcare organization, is seeking a Managed Care Coordinator UM II to join their team. As a Managed Care Coordinator UM II, you will be ... will align successfully in the organization. **Job Title:** Managed Care Coordinator UM II **Location:** Columbia, SC **Pay Range:** Up to $31.25/HR **What's the… more
- Molina Healthcare (Sterling Heights, MI)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing ... and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** The Lead Pharmacist, Utilization Management ( UM ) will serve as a team lead to support the pharmacy… more
- Elevance Health (Indianapolis, IN)
- …and outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact:** + Uses appropriate screening ... healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to...if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis… more
- Elevance Health (Indianapolis, IN)
- …and outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact:** + Coordinating utilization management ... process including appropriate use of UM Clinical Guidelines to refer cases to Peer Reviewers....if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis… more
- USAA (MD)
- …special and impactful. **The Opportunity** We are seeking a dedicated Trial Attorney (BI/ UM ) for either our Washington, DC metro area or northern Virginia staff ... personal injury insurance defense including liability and damages defending first party BI/ UM claims. + Experience preparing reports and memos for Claims including… 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 Division ... University of Miami Pre-College program to teach non-credit courses for the UM Academies. Candidates must have a Master's degree, however, Ph.D. preferred.… more
- Centers Plan for Healthy Living (Jamaica, NY)
- UM RN 90-27 Sutphin Blvd, Jamaica, NY 11435, USA Req #12129 Monday, December 2, 2024 Centers Plan for Healthy Living's goal is to create the ultimate healthcare ... of medically necessary services in coordination with the care management department. Review of care management documentation and outcomes evaluation to ensure member… more