- Molina Healthcare (Albuquerque, NM)
- …healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina...such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only). Must be able… more
- Molina Healthcare (Albuquerque, NM)
- …Experience** Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care , for… more
- Molina Healthcare (Las Cruces, NM)
- …Experience Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care , for… more
- Molina Healthcare (Rio Rancho, NM)
- …Experience** Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care ,… more
- Molina Healthcare (NM)
- …team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care , ... staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of… more
- Molina Healthcare (Santa Fe, NM)
- …team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care , ... staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of… more
- Veterans Affairs, Veterans Health Administration (Albuquerque, NM)
- …when the standard of care may have not been met and where a review of individual clinician decisions and actions may be indicated. Develops and maintains ... Summary The New Mexico VA Health Care System is looking for a Registered Nurse - Peer Review - Quality & Patient Safety (QPS) Team! Responsibilities The Quality,… more
- Veterans Affairs, Veterans Health Administration (Albuquerque, NM)
- …with State and Federal guidelines regarding MDS assessments. Completes Nursing and Care Area Assessments (CAA) summaries as indicated by the type of assessment ... and completion of the MDS and identification of the care plan revision. Responsible for setting the RUG levels...by monitoring a resident's physical and psychosocial state. Upon review of the data, advise the IDT team whether… more
- Prime Therapeutics (Santa Fe, NM)
- …Account Manager - Georgia PDL - Remote **Job Description** Innovative business clinician accountable for building and maintaining customer relationships as well as ... to the customer, derived from identifying, demonstrating and selling valued pharmaceutical care and cost solutions that meet the desired outcomes of the customer;… more