- Baystate Health (Springfield, MA)
- …for exempt employees. Minimum - Midpoint - Maximum $87,859.00 - $100,984.00 - $119,412.00 ** UM Outpatient Clinical Review Nurse- Baystate Health, Health New ... **remote opportunity** **.** **Current States Eligible MA and CT** The ** UM Outpatient Clinical Review Nurse** contributes to the overall success of… more
- Healthfirst (NY)
- …institution or equivalent work experience + NYS RN + Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care ... management for all utilization management functions, including prior authorization, concurrent review , and service requests + Lead, coach, and develop UM… more
- 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 ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- Baystate Health (Springfield, MA)
- …**Required Education/Experience:** + Massachusetts RN license required + 3-5 years' experience as a UM Clinical Review Nurse for a Health Plan + ... - Midpoint - Maximum $96,137.00 - $110,510.00 - $130,728.00 ** UM Regulatory Nurse Specialist - Baystate Health, Health New...This position will also manage all requirements around coding review for the department. This position works to ensure… more
- UPMC (Pittsburgh, PA)
- …is hiring a full-time Utilization Management ( UM ) Care Manager to join the UM Clinical Operations team. This position will be work from home, but preference ... will be given to Pennsylvania-based candidates. The Utilization Management ( UM ) Care Manager is responsible for utilization review of health plan services and… more
- Elevance Health (Cerritos, CA)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... **Behavioral Health Care Manager II, UM ** **Location:** California **Virtual:** This role enables associates...outpatient professional treatment health benefits through telephonic or written review . This role is a part of the team… more
- Healthfirst (NY)
- …on dosing, indication, weight, BMI and other clinical considerations + Develop clinical criteria and medical policies for the review of medications + Ensure ... **Duties & Responsibilities:** + Monitor and review prior authorization requests for medications + Calculate...standing. + Work experience conducting prior authorization reviews + Clinical knowledge of pharmaceuticals and disease states in order… more
- Centene Corporation (Jefferson City, MO)
- …experience with ensuring high quality medical director training to review Medicare UM and appeals, Clinical review quality oversight and management. + ... Assist in the development and implementation of physician education with respect to clinical issues and policies. + Identify utilization review studies and… more
- UCLA Health (Los Angeles, CA)
- …clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, ... Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays a vital...benefit coverage. + Applies UCLA Health protocols and national clinical guidelines (eg, InterQual, Milliman) in review … more
- CVS Health (IL)
- …determinations for inpatient and outpatient services by applying utilization management ( UM ) criteria, clinical judgment, and internal policies and procedures. ... Post-Acute, and Pre-service (Expedited, Standard, and Retrospective) Use evidence-based criteria and clinical reasoning to make UM determinations in concert with… more
Recent Jobs
-
Material Handling Equipment Technician I $5,000 Sign-on Bonus
- Sysco (Lihue, HI)
-
Certified Phlebotomy Technician Lab Assistant II
- Sutter Health (Sunnyvale, CA)