- Molina Healthcare (Bellevue, WA)
- …our Washington State Plan. We are seeking a Registered Nurse with previous UM medical review experience. The candidate must have Pediatric Inpatient experience. ... all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence...programs. + Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies… more
- Healthfirst (WA)
- …Monitors assigned case load to meet performance metric requirements + Functions as a clinical resource for the multi-disciplinary care team in order to maximize ... State + Department of Health (NYSDOH) regulations governing medical management in managed care + Relevant clinical work experience + Intermediate Outlook, Basic… more
- Molina Healthcare (Tacoma, WA)
- …other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional ... (RN) license in good standing. **Preferred Experience** Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review / Utilization… more
- Molina Healthcare (Everett, WA)
- …other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional ... or a compact licensure. The ideal candidate will have experience with UM and prior authorization, within both Physical Health and Behavioral Health. Candidates… more
- Molina Healthcare (Bellevue, WA)
- …field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or ... programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies...LPCC or LMFT (for Behavioral Health Care Review Clinicians only). **Preferred Experience** 3-5 years clinical… more
- Molina Healthcare (Everett, WA)
- …other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional ... with some weekends and holidays.** Preferred Experience Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review / Utilization… more
- Molina Healthcare (Everett, WA)
- …of Nursing. Bachelor's Degree in Nursing preferred. **Preferred Experience** 3-5 years clinical practice with managed care , hospital nursing, utilization and/or ... assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term...illness and the site of service. The Lead, HCS ( Clinical ) functions as clinical staff lead in… more
- Providence (Olympia, WA)
- **Description** The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management ( ... UM ), medical necessity and patient status determination. This individual...Associate's Degree in Nursing + 3 years of Utilization Review , Care Management, Quality Management, and/or Discharge… more
- Virginia Mason Franciscan Health (Seattle, WA)
- …(CCM), Accredited Case Manager (ACM-RN), or UM Certification preferredAble to apply clinical guidelines to ensure progression of care . + Knowledge of managed ... relevant health team members, the patient and/or patient representative and post-acute care providers in accordance with the patients clinical or psychosocial… more
- Evolent (Olympia, WA)
- … expertise in developing cardiovascular programs that include improvements to clinical effectiveness of utilization management ( UM ) and risk-based models.** ... Process improvement and enhancement of **provider engagement to help ensure high value care delivery.** + Offer ** clinical rationale for standard and expedited… more