- University of Michigan (Ann Arbor, MI)
- Chief Clinical Risk Officer, UM Health Apply Now **Mission Statement** Michigan Medicine improves the health of patients, populations and communities through ... as, Corporate Compliance Committee, Patient Safety Committee, Health Information Management, Clinical Care Review Committee, Claims Management Committee, Annual… 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
- CVS Health (OK)
- …needs LCSW, LCPC, RN with experience in psychiatric setting required. Utilizes clinical skills to coordinate, document and communicate all aspects of the ... is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon… 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
- Humana (Frankfort, KY)
- …support assignments. Performs computations. Typically works on semi-routine assignments. The UM Administration Coordinator + Provides non- clinical support for ... part of our caring community and help us put health first** The UM Administration Coordinator 2 contributes to administration of utilization management for Humana's… more
- Guthrie (Binghamton, NY)
- …management. 7. Seeks consultation from appropriate discipline/department as needed to expedite clinical review of potential and actual denials. + Education 1. ... RN responsibilities include performing a variety of concurrent and retrospective UM -related clinical reviews and revenue cycle functions ensuring appropriate… more
- MVP Health Care (Tarrytown, NY)
- …and continuous improvement. To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have a passion ... for patient-centered advocacy, clinical precision and regulatory compliance this is an opportunity...+ Experience with electronic medical record (EMR) systems and UM platforms. + Familiarity with CMS regulations and appeals… more
- Commonwealth Care Alliance (Boston, MA)
- …to the Manager Utilization Management, the Nurse Utilization Management ( UM ) Reviewer is responsible for day-to-day timely clinical and service authorization ... does not have direct reports. **Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a… 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 ... companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive… more
- Elevance Health (Columbus, OH)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... Health family of companies, **Carelon Behavioral Health** , offers superior clinical mental health and substance use disorder management, a comprehensive employee… more
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