- Point32Health (MA)
- …+ Performs other roles/duties and projects as assigned by the Pharmacy UM Supervisor or Director **Salary Range** $107,646.86 -$161,470.30 **Compensation & ... . **Job Summary** Under the direction of the Pharmacy Utilization Management ( UM ) Supervisor, the Clinical Pharmacist is responsible for reviewing, processing and… more
- HCA Healthcare (Englewood, CO)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision...perform other duties as assigned by the Case Management Director and cover for the director as… more
- University of Southern California (Alhambra, CA)
- …Care Management Coordinators. 4. Makes appropriate referrals to supervisor or Medical Director , communicating accurate clinical information. 5. Participates in ... 1. Demonstrates sound clinical knowledge base regarding CM standards, UM standards, clinical standards of care, NCQA requirements, CMS...(MCG and/or InterQual) competency testing as requested by department director or Medical Director . +… more
- University of Miami (Miami, FL)
- …ADDENDUM Department Specific Functions + Provide support for Radiology Division director and it's division members: + Travel Requests and Business Reimbursements: ... Support: + Assist in faculty on-boarding (ID Badge for UM and JHS, access, lab-coats, Scrub access At ...(Abdominal Division only)) + Manage Outlook calendars for Division Director and other division faculty members as needed. +… more
- Elevance Health (Indianapolis, IN)
- …nursing judgment to determine whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not satisfy ... not in line with diagnosis. + Provide consultation to Medical Director on particularly peculiar or complex...in multiple states. **Preferred skills, qualifications and experiences:** + UM experience in either Provider or Managed Care space… more
- Saint Francis Health System (OK)
- …Triggers for individual patient situations, reporting them promptly to the UM Manager, appropriate clinicians and Process Improvement/Quality Director . Reviews ... levels of care and receipt of necessary services. The Utilization Management ( UM ) Registered Nurse will communicate with providers the details of reimbursement… more
- Evolent (Olympia, WA)
- …participate in meetings as assigned with practices and/or payers. Will work with the Director of UM to ensure client satisfaction. Perform all peer clinical ... under the auspices of the office of the Chief Medical Officer. **ESSENTIAL DUTIES AND RESPONSIBILITIES** : include the...with one of the cardiologists. Responsible for coordinating with UM staff to ensure timely and accurate communication of… more
- CommonSpirit Health (Salt Lake City, UT)
- …a collaborative partnership with the Medical Director CDI, Enterprise Director Case Management, UM Hub Director , and Care Coordination Leaders ... City Area._ The Physician Advisor reports directly to the Medical Director Physician Advisor/UR and is responsible...position provides support to the facility Utilization Management Committees, medical staff, UM Hub, and care coordination… more
- BronxCare Health System (Bronx, NY)
- …activities and monitoring on a quarterly basis and reports findings/analysis to Director . - Conducts educational/feedback sessions with UM staff related to ... - Reviews and denials notification letters along with the medical records and all pertinent documentation related to the...response for submission in appeal. - In absence of Director , will review denial correspondence to determine validity of… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …other assigned duties to meet required turnaround times. * Prepares and presents cases to Medical Director (MD) for medical director oversight and ... services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with...URAC and NCQA. * 2+ years' experience in a UM team within managed care setting. * 3+ years'… more