- US Tech Solutions (Columbia, SC)
- …back up review determinations. Identifies and makes referrals to appropriate staff ( Medical Director , Case Manager, Preventive Services, Subrogation, Quality of ... week. + M-F 8:30am - 5pm. + From the Manager: -Experience: Hospital experience, UM experience -Description: office work, at a desk 8 hours per day, reading clinical… more
- Highmark Health (Wexford, PA)
- …) coverage requests and prepares such cases for clinical review by a pharmacist and/or medical director when required. (20%) + Within the context of the request, ... (15%) + Responsible for all preauthorization entries into applicable databases (ie internal medical claims systems, PBM pharmacy systems) to ensure swift… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …to ensure appropriate coordination of care\. + Seek the advice of the Medical Director when appropriate, according to policy\. + Assists non\-clinical staff ... for letters, retrospective claim review, special review requests, and UM pre\-certifications and appeals, utilizing medical appropriateness criteria,… more
- University of Miami (Miami, FL)
- …+ Organized, detail oriented, excellent people and communication skills, and knowledge of UM medical school research environment. #LI-YC1 The University of Miami ... (https://www.myworkday.com/umiami/d/task/1422$7248.htmld) to log in to Workday to use the internal application process. To learn how to apply for...Sr. Research Associate 3 to work at the UHealth Medical Campus in Miami, FL. CORE SUMMARY The Sr.… more
- Ellis Medicine (Schenectady, NY)
- …discharge condition and final discharge plans. + Assists with ordering durable medical equipment. + Meets with patient, family and/or designee to ensure post-acute ... continuity of care and decrease length of stay + Appropriately refer and elevate medical and/or complex needs to appropriate case management and social work staff to… more
- LA Care Health Plan (Los Angeles, CA)
- …to the Supervisor of ECM and receives clinical supervision as needed from the Medical Director of Care Management. The position is responsible for providing ... ECM Providers with the coordination of member care with internal LA Care departments such as Care Management (CM),...Care departments such as Care Management (CM), Utilization Management ( UM ), Managed Long Term Services and Support (MLTSS), Social… more