- Evolent (San Juan, PR)
- …coordinating with UM staff to ensure timely and accurate communication of clinical decisions. Responsible for completion of UM projects and participation in ... with the Director of UM to ensure client satisfaction. Perform all peer clinical review activities while located in a state or territory of the United States.… more
- Datavant (San Juan, PR)
- …recognized medical necessity criteria and standards of care, along with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed ... Practical Nurse or Registered Nurse well versed in...denials and appeal writing for inpatient admission. Experience with clinical criteria resources and payor guidelines. **You will:** +… more
- Sharecare (San Juan, PR)
- …available 3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and ... hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management ( UM ) status, including but not limited to medical, dental, and vision… more