- Healthfirst (NY)
- …accredited institution or equivalent work experience** **NYS RN** **Demonstrated understanding of UM regulatory requirements, clinical review process, and ... review , and service requests** **Lead, coach, and develop UM managers overseeing interdisciplinary teams of registered nurses, social workers, clinicians,… more
- Molina Healthcare (Salt Lake City, UT)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are ... regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and… 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 (Hartford, CT)
- …manages the implementation of strategic initiatives for the Utilization Management ( UM ) Clinical Services organization. These initiatives leverage technical ... standards and other healthcare integration standards + Familiarity with clinical workflows, utilization review processes, and InterQual/MCG guidelines.… 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
- CareFirst (Baltimore, MD)
- …+ Provide deep subject matter expertise in all areas of Utilization Management ( UM ), including pre-service, concurrent review , and inpatient management, with a ... experience in business development, operational technology support, Utilization Management ( UM ) operations, Clinical Product Configuration, Health Plan… more
- Humana (Austin, TX)
- …with other team members. **Achieve your best at Humana. Join Us!** The UM Administration Coordinator provides non- clinical support for the policies and ... Solutions UM Team is hiring for a UM Administration Coordinator 2 that will provide non- clinical...the nursing team + Builds and pends authorizations for review + Responsible for inbound and outbound calls to… more
- Integra Partners (Troy, MI)
- …Take accountability for overall team performance, escalating issues as needed to the UM Clinical Manager. + Ensure compliance with all regulatory, contractual, ... The Utilization Management ( UM ) Nurse Supervisor is responsible for providing direct...necessity criteria (eg, InterQual, CMS, health plan policies). + Review and process clinical and administrative appeals;… more
- Point32Health (MA)
- …issues with pharmacy technicians and confer with other clinical pharmacist on review questions + Communicate with UM staff and providers when issues arise ... . **Job Summary** Under the direction of the Pharmacy Utilization Management ( UM ) Supervisor, the Clinical Pharmacist is responsible for reviewing, processing… more
- Humana (Bismarck, ND)
- …support assignments. Performs computations. Typically works on semi-routine assignments. The UM Administration Coordinator 2 provides non- clinical support for ... a part of our caring community and help us put health first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM … more
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