• Medical Review Nurse (RN)- Remote

    Molina Healthcare (Rio Rancho, NM)
    …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. + ... of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. + Provides training and… more
    Molina Healthcare (01/09/26)
    - Related Jobs

  • Director, Clinical Care Services - New Mexico,…

    Magellan Health Services (Albuquerque, NM)
    …initiatives with providers and members to manage cost of care. Oversees utilization management and criteria-based reviews of care, clinical appeals regarding medical ... with claims payment policies and processes. Also oversees the health plans 24/7 Nurse Line program and the clinical management of crisis calls. Depending on… more
    Magellan Health Services (01/08/26)
    - Related Jobs

  • Manager, Clinical Care Services

    Magellan Health Services (Albuquerque, NM)
    …and coordination of clinical and/or nonclinical management staff, including utilization management and intensive care management staff, providing expertise in ... and other metrics. + Supervises care management staff through approved audit processes including performing annual reviews and provides counseling and disciplinary… more
    Magellan Health Services (01/08/26)
    - Related Jobs

  • Attending Physician

    Genesis Healthcare (Albuquerque, NM)
    …among residents of skilled nursing and senior living facilities. Our physicians, nurse practitioners (NPs) and physician assistants (PAs) are supported by a clinical ... assigned Centers and AlignMed Partners managers to oversee the implementation, utilization , and outcomes measurement of AlignMed Partners Clinical Programs and… more
    Genesis Healthcare (11/12/25)
    - Related Jobs