- Centers Plan for Healthy Living (Margate, FL)
- …applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help ... home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all...care managers and believe that coordinating high quality clinical and social services will result in better … more
- Magellan Health Services (Honolulu, HI)
- …implement solutions that directly influence quality of care . General Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 ... - Required CEAP - Certified Employee Assistance Professional - Care MgmtCare Mgmt, LCSW - Licensed Clinical Social Worker - Care MgmtCare Mgmt, LMFT… more
- AmeriHealth Caritas (Lafayette, LA)
- …perform a thorough medical necessity review . It is within the BH UM Reviewer 's discretion to retain requests for additional information and/or request ... is responsible for completing medical necessity reviews. Using clinical knowledge and experience, the clinician reviews provider requests...integrated care management as needed. The BH UM Reviewer will apply medical health benefit… more
- Commonwealth Care Alliance (Boston, MA)
- …the provisions of CCA's benefits plan. The Utilization Management ( UM ) Reviewer is responsible for day-to-day timely clinical and service authorization ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for… more
- BlueCross BlueShield of Tennessee (Knoxville, TN)
- **Join Our Team as a Behavioral Health Clinical Review Manager\!** Are you a licensed Behavioral Health Clinician or RN with at least 3 years of hands\-on ... looking for a dedicated professional like you to help ensure members receive the care they need\. In this role, you'll review inpatient and outpatient behavioral… more
- Dignity Health (Rancho Cordova, CA)
- …that provides a clinical and financial approach through the continuum of care . Promotes the quality and cost effectiveness of medical care by ensuring ... reviews correct selection of criteria accurate prep to the UM Physician reviewer when indicated timely verbal...required. - 3 years Utilization experience required in health plan/ UM operations, Acute or subacute utilization review .… more
- Molina Healthcare (Bellevue, WA)
- …our Washington State Plan. We are seeking a Registered Nurse with previous UM medical review experience. The candidate must have Pediatric Inpatient experience. ... all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence...programs. + Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies… more
- Guthrie (Troy, PA)
- Up to a $15,000.00 Sign on Bonus! Summary The LPN Utilization Management ( UM ) Reviewer , in collaboration with Care Coordination, Guthrie Clinic offices, ... associated with UM processes and operations. Experience Minimum of five years clinical experience in an acute health care setting. Must possess strong… more
- Dignity Health (Bakersfield, CA)
- …criteria used for decision-making. - Ensures that there is evidence that the UM nurse reviewer documented communications with the requesting provider to validate ... management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health… more
- UPMC (Pittsburgh, PA)
- …Health Plan is hiring a flex full-time UM Care Manager to support our UM Clinical Operations team. This role will work 8 - 10 hours shifts on Saturdays ... Pennsylvania RN license. The Utilization Management ( UM ) Care Manager is responsible for utilization review ...effective manner. **Responsibilities:** + Review and document clinical information from health care providers including… more