- Molina Healthcare (Spokane, WA)
- …healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or ... state LPN licensure. Candidates with case management, Utilization Management ( UM ), and direct managed care experience are...such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only). Must be able… more
- Molina Healthcare (Houston, TX)
- …to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in the state of Texas. You...concurrent reviews. Preference will be given to those whose UM experience is within another MCO like Molina; experience… more
- Molina Healthcare (Idaho Falls, ID)
- …to 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
- Monte Nido (Miami, FL)
- …comprehensive care within an intimate home setting. The Utilization Review ** Clinician ** is responsible for conducting daily administrative and professional ... opportunity for people to realize their healthy selves. **Utilization Review Clinician ** **Monte Nido** **Remote - EST...active treatment team member providing payor needs for next review , guidance on level of care recommendations,… more
- Molina Healthcare (Meridian, ID)
- …to 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 (Los Angeles, CA)
- …to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional ... in Nursing **Preferred Experience** Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review... Care , ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual /… more
- Molina Healthcare (Omaha, NE)
- …to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional ... and holidays.** Preferred Experience Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review... Care , ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual /… more
- Commonwealth Care Alliance (Boston, MA)
- …with the VP of UM to direct the efforts of the utilization review and pre-certification functions to accomplish objectives within policy and budget. + Serve as a ... the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will...on a weekly basis + Provide education to internal care management and clinician staff + Provide… more
- US Tech Solutions (Chicago, IL)
- …+ MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... objectives **Responsibilities:** + Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. +… more
- US Tech Solutions (May, OK)
- …. MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF ... objectives Responsibilities: . Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. .… more