- CVS Health (Santa Fe, NM)
- …promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team **Position Summary** The ... a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective...projects. Acting as the first point of contact for clinical issues, the Team Lead provides guidance… more
- Molina Healthcare (NM)
- …Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... and monitoring clinical and non- clinical team activities to facilitate integrated, proactive utilization ... team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and… more
- Humana (Santa Fe, NM)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...to work independently under general instructions and with a team + Must be passionate about contributing to an… more
- CenterWell (Santa Fe, NM)
- …caring community and help us put health first** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical expert responsible for conducting medical ... peak season **Job Description:** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical professional...ability to work effectively both independently and in a team environment + Strong problem-solving skills and the ability… more
- CVS Health (Santa Fe, NM)
- …healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team . In this role, you'll ... be at the forefront of clinical decision-making, applying your expertise in Behavioral Health to...a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM… more
- Humana (Santa Fe, NM)
- …put health first** The UM Administration Coordinator contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... at Humana. Join Us!** The UM Administration Coordinator provides non- clinical support for the policies and procedures ensuring best...care or services for members. The Home Solutions UM Team is hiring for a UM Administration Coordinator that… more
- Prime Therapeutics (Santa Fe, NM)
- …Develop and present clinical program solutions, including formulary and utilization management recommendations, to Administrative Services Only (ASO) groups ... understand current industry trends and illustrate expert knowledge of clinical products and formulary management strategies in...utilization patterns and trend impact + Support account team in sales and retention efforts, formulary and … more
- Intermountain Health (Santa Fe, NM)
- …specialty care settings or previous appeals experience. + Demonstrated experience in utilization review and/or case management , hospital insurance billing, third ... The RCO Audit & Appeals RN Consultant is responsible for consulting on clinical Appeals and Audits for Intermountain Health. The Audit/Appeals RN Consultant will… more
- Prime Therapeutics (Santa Fe, NM)
- … clinical programs and drug strategy recommendations including drug formulary, Utilization Management programs, and other drug therapy related products and ... Remote **Job Description** **This is an Individual Contributor/Client Facing Role.** The Clinical Account Director is responsible for the management of all… more
- Children's Home Healthcare (Albuquerque, NM)
- …have excellent communication skills and willing to travel to patient homes + Utilization Management Experience + Reliable transportation for patient visits + ... families. Come be a part of this growing professional team ! We are seeking an experienced Clinical ...Home Health services from insurance company. 7. Attend quarterly Utilization Review meetings as designated by the Director of… more