- Molina Healthcare (Las Cruces, NM)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and… more
- 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
- Genesis Healthcare (Santa Fe, 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
- YesCare Corp (Las Cruces, NM)
- …schedule. Weekdays or weekends **Administrative** + Serve as Chairman of the Medical Audit Committee. + Consult with medical providers in the community to resolve ... of care and chart reviews as requested. Sponsors physician assistants or nurse practitioners as required. + Notifies Regional Medical Director and Site Health… more