- Evolent (Olympia, WA)
- …mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance ... for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices of...under the auspices of the office of the Chief Medical Officer. **ESSENTIAL DUTIES AND RESPONSIBILITIES** : include the… more
- University of Michigan (Ann Arbor, MI)
- …Qualifications ** Nurse Practitioners** + Current licensure to practice as a Registered Nurse and Nurse Practitioner specialty certification in the ... and collaborative educational series. + Orient and precept newly onboarding APPs, nurse practitioner students, physician assistant students, and medical students… more
- Elevance Health (Walnut Creek, CA)
- …offers superior clinical mental health and substance use disorder management , a comprehensive employee assistance program, work/life support, specialty programs ... healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to...equivalent background. + Current active unrestricted license such as RN LCSW LMSW LMHC LPC LBA (as allowed by… more
- Dignity Health (Gilbert, AZ)
- … RN License Preferred: + Certified Case Manager (CCM), Accredited Case Manager (ACM- RN ), or UM Certification Training: + Knowledge of managed care and payer ... **Job Summary and Responsibilities** The Care Coordination Department at Mercy Gilbert Medical Center plays a critical role in providing exceptional patient care to… more
- Centene Corporation (Salem, OR)
- …everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization ... for all appeals utilizing nationally recognized criteria to determine medical necessity of services requested. + Prepare reviews for...LPN, LVN, or RN license. **Texas Requirements:** RN license required within Utilization Management at… more
- Elevance Health (NC)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... an equivalent background. Current active unrestricted license, such as RN LCSW LMSW LMHC LPC LBA (as allowed by...if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis… more
- Elevance Health (Metairie, LA)
- …necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... equivalent background. + Current active unrestricted license, such as RN , LCSW, LMSW, LMHC, LPC, LBA (as allowed by...if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis… more
- Elevance Health (FL)
- …treatment health benefits through telephonic or written review. The BH Care Manager ( UM ) job progression is primarily a provider-facing role although it does involve ... behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to...equivalent background. + Current active unrestricted license such as RN LCSW LMSW LMHC or (as allowed by applicable… more
- Martin's Point Health Care (Portland, ME)
- …experience as an RN , preferably in a hospital setting + Utilization management experience in a health plan UM department Required License(s) and/or ... committees, work groups, projects, and process improvements that reinforce best practice medical management programming and offerings. + Participates in the… more
- Molina Healthcare (Louisville, KY)
- …with multidisciplinary teams to promote Molina care model. * Adheres to utilization management ( UM ) policies and procedures. * May work collaboratively with ... a Licensed Masters Level social worker, counselor, therapist and/or RN with a current active license for state of...with behavioral health medical directors, and senior medical directors to ensure proper management of… more